Does staged surgical training for minimally invasive esophagectomy have an impact on short-term outcomes?
Does staged surgical training for minimally invasive esophagectomy have an impact on short-term outcomes?
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DOI：
10.1007/s00464-020-08125-y
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发表时间：
2020-10-30
影响因子：
3.1
通讯作者：
Daiko, Hiroyuki
中科院分区：
文献类型：
--
作者：
Ishiyama, Koshiro;Fujita, Takeo;Daiko, Hiroyuki
背景 食管癌发病率较低，食管切除术时解剖结构难以理解。这需要精确且漫长的操作。因此，建立食管外科培训体系至关重要。在这项研究中，我们比较了顾问与学员进行微创食管切除术（MIE）的短期结果，并探讨了影响每组胸腔手术时间的因素。方法我们于2016年向学员介绍了标准化的MIE手术技术。我们的手术包括腹腔镜阶段和胸腔镜阶段，并且系统地设计为每个阶段循序渐进地学习。我们回顾性分析了2016年4月至2018年4月期间接受MIE治疗的308名患者。患者分为由顾问接受MIE治疗的患者和由实习生接受MIE治疗的患者。比较两组患者术前背景因素、手术相关因素及术后并发症情况。我们还评估了每位会诊者和受训者的胸部手术时间延长与肿瘤和患者相关因素之间的关联。结果 顾问组中患有≥ III 期癌症的患者明显多于受训者组。然而，术后并发症相当，特别是肺炎（11% vs. 18%）、吻合口瘘（11% vs. 13%）和死亡率（0.6% vs. 1.3%）。两组之间的淋巴结产量（20 比 17）或 R0 切除率（94% 比 91%）没有显着差异。然而，受训者的胸部手术时间明显更长（143 +/- 34 与 190 +/- 28 分钟），失血量也明显增多（93 毫升与 183 毫升）。在咨询师中，肿瘤因素与延长的胸部手术时间相关，但在受训者中则不然。结论 在使用逐步教育计划的标准化手术管理下，受训者的 MIE 表现对短期结果没有影响。
Background sophageal cancer has a low incidence, and the anatomy is difficult to understand during esophagectomy. This necessitates a precise and lengthy operation. Therefore, the establishment of a training system in esophageal surgery is of critical importance. In this study, we compared the short-term outcomes of minimally invasive esophagectomy (MIE) performed by consultants versus trainees and explored the factors that impacted the thoracic operation time for each group. Methods We have introduced standardized MIE surgical techniques to our trainees in 2016. Our procedure consists of a laparoscopic phase and a thoracoscopic phase and is systematically designed to be learned in a step-by-step manner in each phase. We retrospectively identified 308 patients who underwent MIE from April 2016 to April 2018. The patients were divided into those who underwent MIE by consultants and those who underwent MIE by trainees. The preoperative background factors, operation-related factors, and postoperative complications were compared between the two groups. We also assessed the association between a prolonged thoracic operation time and tumor-and patient-related factors in each of the consults and trainees. Results Significantly more patients had stage >= III cancer in the consultant than trainee group. However, the postoperative complications were comparable, specifically pneumonia (11% vs. 18%), anastomotic leakage (11% vs. 13%), and mortality (0.6% vs. 1.3%). There was no significant difference in the lymph node yield (20 vs. 17) or R0 resection rate (94% vs. 91%) between the two groups. However, the trainees had a significantly longer thoracic operation time (143 +/- 34 vs. 190 +/- 28 min) and significantly greater blood loss (93 vs. 183 ml). Oncological factors were correlated with a prolonged thoracic operation time in the consultants, but not in the trainees. Conclusions Under standardized surgical management using a stepwise educational program, performance of MIE by trainees has no impact on short-term outcomes.