Abstract
Background
The aim of this study was to investigate the learning curves (LCs) of single-port laparoscopic surgery (SPLS) for colon cancer using multidimensional statistical analyses. Although SPLS yields better cosmetic results and comparable short-term outcomes compared to conventional laparoscopic surgery, its technical difficulties make surgeons hesitant to try SPLS. Moreover, the LCs of SPLS for colon cancer are not well delineated.
Methods
Data were collected from patients who underwent SPLS for colon cancer in seven Korean institutions between May 2009 and May 2015. The LCs were analyzed using the moving average method and the cumulative sum control chart (CUSUM) for operation time and surgical failure. Surgical failure was defined as the any conversion, postoperative complications, or less than 12 harvested lymph nodes from surgical specimens.
Results
A total of 356 patients were included in this study. Six and three surgeons performed 282 anterior resections (ARs) and 74 right colectomies (RCs), respectively. On the basis of the moving average method and CUSUM for operation time and surgical failure, the LCs for AR were 18, 16, 35, 13, 36, and 13 cases for surgeons A–F, respectively. However, the LCs for RC were 6 and 15 cases for surgeons D and E, respectively, and were ambiguous for one surgeon.
Conclusions
For surgeons experienced in conventional laparoscopic colorectal surgery, the LCs of SPLS for colon cancer ranged from 6 to 36 cases, which is shorter than the LCs reported for conventional laparoscopic surgery.
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References
Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229
Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059
Champagne BJ, Papaconstantinou HT, Parmar SS, Nagle DA, Young-Fadok TM, Lee EC, Delaney CP (2012) Single-incision versus standard multiport laparoscopic colectomy: a multicenter, case-controlled comparison. Ann Surg 255:66–69
Maggiori L, Gaujoux S, Tribillon E, Bretagnol F, Panis Y (2012) Single-incision laparoscopy for colorectal resection: a systematic review and meta-analysis of more than a thousand procedures. Colorectal Dis 14:e643–654
Poon JT, Cheung CW, Fan JK, Lo OS, Law WL (2012) Single-incision versus conventional laparoscopic colectomy for colonic neoplasm: a randomized, controlled trial. Surg Endosc 26:2729–2734
Osborne AJ, Lim J, Gash KJ, Chaudhary B, Dixon AR (2013) Comparison of single-incision laparoscopic high anterior resection with standard laparoscopic high anterior resection. Colorectal Dis 15:329–333
Kim HJ, Kang BM, Lee SH, Lee SC, Lee KY, Park SJ, Lim SW, Kim JG (2014) Single-port laparoscopic colorectal cancer surgery in Korea: retrospective analysis of the multicenter, pooled database. J Laparoendosc Adv Surg Tech A 24:462–465
Kim CW, Cho MS, Baek SJ, Hur H, Min BS, Kang J, Baik SH, Lee KY, Kim NK (2015) Oncologic outcomes of single-incision versus conventional laparoscopic anterior resection for sigmoid colon cancer: a propensity-score matching analysis. Ann Surg Oncol 22:924–930
Yun JA, Yun SH, Park YA, Huh JW, Cho YB, Kim HC, Lee WY (2016) Oncologic outcomes of single-incision laparoscopic surgery compared with conventional laparoscopy for colon cancer. Ann Surg 263:973–978
Kim CW, Kim WR, Kim HY, Kang J, Hur H, Min BS, Baik SH, Lee KY, Kim NK (2015) Learning curve for single-incision laparoscopic anterior resection for sigmoid colon cancer. J Am Coll Surg 221:397–403
Park Y, Yong YG, Yun SH, Jung KU, Huh JW, Cho YB, Kim HC, Lee WY, Chun HK (2015) Learning curves for single incision and conventional laparoscopic right hemicolectomy: a multidimensional analysis. Ann Surg Treat Res 88:269–275
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Haas EM, Nieto J, Ragupathi M, Aminian A, Patel CB (2013) Critical appraisal of learning curve for single incision laparoscopic right colectomy. Surg Endosc 27:4499–4503
Hopping JR, Bardakcioglu O (2013) Single-port laparoscopic right hemicolectomy: the learning curve. J Soc Laparoendosc Surg 17:194–197
Kirk KA, Boone BA, Evans L, Evans S, Bartlett DL, Holtzman MP (2015) Analysis of outcomes for single-incision laparoscopic surgery (SILS) right colectomy reveals a minimal learning curve. Surg Endosc 29:1356–1362
Dincler S, Koller MT, Steurer J, Bachmann LM, Christen D, Buchmann P (2003) Multidimensional analysis of learning curves in laparoscopic sigmoid resection: eight-year results. Dis Colon Rectum 46:1371–1378
Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242:83–91
Choi DH, Jeong WK, Lim SW, Chung TS, Park JI, Lim SB, Choi HS, Nam BH, Chang HJ, Jeong SY (2009) Learning curves for laparoscopic sigmoidectomy used to manage curable sigmoid colon cancer: single-institute, three-surgeon experience. Surg Endosc 23:622–628
Bege T, Lelong B, Esterni B, Turrini O, Guiramand J, Francon D, Mokart D, Houvenaeghel G, Giovannini M, Delpero JR (2010) The learning curve for the laparoscopic approach to conservative mesorectal excision for rectal cancer: lessons drawn from a single institution’s experience. Ann Surg 251:249–253
Park EJ, Kim CW, Cho MS, Baik SH, Kim DW, Min BS, Lee KY, Kim NK (2014) Multidimensional analyses of the learning curve of robotic low anterior resection for rectal cancer: 3-phase learning process comparison. Surg Endosc 28:2821–2831
Funding
This study was funded by the Korean Society of Endoscopic and Laparoscopic Surgeons.
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The content is the responsibility of the authors and does not necessarily represent the official views of the Korean Society of Endoscopic and Laparoscopic Surgeons. Drs. Chang Woo Kim, Kil Yeon Lee, Sang Chul Lee, Suk-Hwan Lee, Yoon Suk Lee, Sang Woo Lim, and Jun-Gi Kim have no conflicts of interests or additional financial ties to disclose.
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Kim, C.W., Lee, K.Y., Lee, S.C. et al. Learning curve for single-port laparoscopic colon cancer resection: a multicenter observational study. Surg Endosc 31, 1828–1835 (2017). https://doi.org/10.1007/s00464-016-5180-7
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DOI: https://doi.org/10.1007/s00464-016-5180-7