Short-term outcomes and one surgeon's learning curve for thoracoscopic esophagectomy performed with the patient in the prone position
Short-term outcomes and one surgeon's learning curve for thoracoscopic esophagectomy performed with the patient in the prone position
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DOI：
10.1007/s00595-016-1378-5
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发表时间：
2017-03-01
期刊：
影响因子：
2.5
通讯作者：
Kakeji, Yoshihiro
中科院分区：
文献类型：
--
作者：
Oshikiri, Taro;Yasuda, Takashi;Kakeji, Yoshihiro
胸腔镜食管切除术与患者在俯卧位（TEP），现在正在进行微创食管切除术的食管癌。一名外科医生（“外科医生A”）对100名连续患者进行了TEP，根据治疗顺序分为三个阶段。每组包括33或34例患者。比较三组的结果，以确定外科医生专业知识的影响。随着外科医生A在执行该手术方面获得经验，结果得到改善，这可以通过减少第1阶段和第2阶段之间以及第2阶段和第3阶段之间的胸部手术时间来证明（分别为p = 0.0033和p = 0.0326）;第1和第2阶段之间的胸部淋巴结回收数量增加（p = 0.0070）;以及在第2和第3阶段之间喉返神经（RLN）麻痹的下降（p = 0.0450）。第二阶段是每个学习曲线的关键阶段，个体外科医生在100例TEP手术过程中的学习曲线有三个结果：手术时间缩短，胸淋巴结回收数量增加，喉返神经麻痹率降低。大约需要30-60例病例才能在TEP手术中达到平台期并降低发病率。
Thoracoscopic esophagectomy with the patient in the prone position (TEP) is now being performed as minimally invasive esophagectomy for esophageal cancer. This study examines the short-term outcomes and the learning curve associated with TEP.One surgeon ("Surgeon A") performed TEP on 100 consecutive patients assigned to three periods based on treatment order. Each group consisted of 33 or 34 patients. The outcomes of the three groups were compared to define the influence of surgeon expertise.Outcomes improved as Surgeon A gained experience in performing this operation, as evidenced by reduced thoracic operative times between periods 1 and 2, and then between periods 2 and 3 (p = 0.0033 and p = 0.0326, respectively); an increased number of retrieved chest nodes between periods 1 and 2 (p = 0.0070); and a decline in recurrent laryngeal nerve (RLN) palsy between periods 2 and 3 (p = 0.0450). Period 2 was the pivotal period for each learning curve.An individual surgeon's learning curve over the course of 100 TEP procedures had three outcomes: a shortened operative time, a higher number of retrieved chest nodes, and a decreased rate of RLN palsy. Approximately 30-60 cases were needed to reach a plateau in the TEP procedure and a reduction in the morbidity rate.