Transanal total mesorectal excision for rectal cancer: evaluation of the learning curve
Transanal total mesorectal excision for rectal cancer: evaluation of the learning curve
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DOI：
10.1007/s10151-018-1771-8
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发表时间：
2018-04-01
影响因子：
3.3
通讯作者：
Sietses, C.
中科院分区：
文献类型：
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作者：
Koedam, T. W. A.;Helbach, M. Veltcamp;Sietses, C.
背景经肛门直肠全系膜切除术（TaTME）为直肠癌提供了一个从下方观察切缘的良好视角，但由于解剖标志很少而具有挑战性。在实施这项技术的过程中，需要确保患者的安全和最佳结果。本研究的目的是评估TaTME在直肠癌患者中的学习曲线，以优化未来的培训programmes.Methods在2012年2月至2017年1月期间，所有连续的直肠癌TaTME后的患者被纳入一个单中心数据库。使用累积和图和分裂模型评价手术经验对主要术后并发症、渗漏率和手术时间的影响。校正潜在的情况下混合differenties.Results在一段时间的60个月，共138例患者被纳入本研究。根据病例组合进行调整后，在前40例患者后，术后结局明显改善，主要术后并发症从47.5%降至17.5%，渗漏率从27.5%降至5%。平均手术时间（42分钟）和转换率（从10%到零）在过渡到两个团队的方法后较低，但两个终点都没有随着经验而下降。再入院率和再手术率不受手术经验的影响。结论TaTME的学习曲线影响了前40例患者的主要（手术）术后并发症。两个团队的方法减少了手术时间和转换率。在实施这项新技术时，建议进行全面的教学和监督计划，以缩短学习曲线并改善首批患者的临床结果。
Background Transanal total mesorectal excision (TaTME) provides an excellent view of the resection margins for rectal cancer from below, but is challenging due to few anatomical landmarks. During implementation of this technique, patient safety and optimal outcomes need to be ensured. The aim of this study was to evaluate the learning curve of TaTME in patients with rectal cancer in order to optimize future training programs.Methods All consecutive patients after TaTME for rectal cancer between February 2012 and January 2017 were included in a single-center database. Influence of surgical experience on major postoperative complications, leakage rate and operating time was evaluated using cumulative sum charts and the splitting model. Correction for potential case-mix differences was performed.Results Over a period of 60 months, a total of 138 patients were included in this study. Adjusted for case-mix, improvement in postoperative outcomes was clearly seen after the first 40 patients, showing a decrease in major postoperative complications from 47.5 to 17.5% and leakage rate from 27.5 to 5%. Mean operating time (42 min) and conversion rate (from 10% to zero) was lower after transition to a two-team approach, but neither endpoint decreased with experience. Readmission and reoperation rates were not influenced by surgical experience.Conclusions The learning curve of TaTME affected major (surgical) postoperative complications for the first 40 patients. A two-team approach decreased operative time and conversion rate. When implementing this new technique, a thorough teaching and supervisory program is recommended to shorten the learning curve and improve the clinical outcomes of the first patients.