Skip to main content

Advertisement

SpringerLink
Log in

Oncological outcomes of laparoscopic colon resection for cancer after implementation of a full-time preceptorship

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The learning curve for laparoscopic colectomy (LC) is considered long and difficult. The presence of a preceptor may shorten the learning curve of LC and ensure adequate oncologic and short-term results. City of Hope implemented a full-time LC preceptorship between September 2004 and March 2006 with one experienced surgeon assisting other surgeons. We review our outcomes with laparoscopic colon resection for colon adenocarcinoma after implementation of this preceptorship.

Methods

All cases of laparoscopic colon resection for adenocarcinoma performed from September 2004 to April 2009 were retrospectively reviewed. We compared the patients in two groups: group 1 had surgery performed during the preceptorship period from September 2004 to March 2006 (n = 39) and group 2 had procedures done between April 2006 and April 2009 (n = 74). Clinical characteristics evaluated included sex, age, body mass index (BMI), ASA level, and history of previous abdominal surgery. Postoperative variables evaluated included type of operation, conversion to open surgery, estimated blood loss (EBL), operation time, stage, number of harvested lymph nodes, time to liquid diet, postoperative stay, complications, and 30-day mortality rate. Kaplan–Meier survival curves were constructed based on disease-free survival (DFS) and overall survival (OS).

Results

One hundred thirteen patients underwent LC for adenocarcinoma during the study period. Mean age and BMI were similar between the groups. There was also no significant difference in conversion rates (10.3% vs. 13.5%, p = 0.77) or total complications (25.6% vs. 41.9%, p = 0.088) between groups 1 and 2, respectively. There was a significantly greater number of lymph nodes removed in the post-preceptor period (20.3 vs. 15.8, p = 0.007). The 3-year DFS rate was 96.5%, with a mean follow-up of 22.8 months, and the 3-year OS rate was 88.9%, with mean follow-up of 22.1 months, for the entire cohort.

Conclusion

Implementation of a program with a full-time preceptorship can help institutions overcome the challenges of laparoscopic colectomy and achieve acceptable postoperative and oncologic outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1:144–150

    PubMed  CAS  Google Scholar 

  2. Law WL, Lee YM, Choi HK, Seto CL, Ho JW (2007) Impact of laparoscopic resection for colorectal cancer on operative outcomes and survival. Ann Surg 245:1–7

    Article  PubMed  Google Scholar 

  3. 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

    Article  Google Scholar 

  4. Braga M, Frasson M, Vignali A, Zuliani W, Civelli V, Di Carlo V (2005) Laparoscopic vs. open colectomy in cancer patients: long-term complications, quality of life, and survival. Dis Colon Rectum 48:2217–2223

    Article  PubMed  Google Scholar 

  5. Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, Heath RM, Brown JM (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068

    Article  PubMed  Google Scholar 

  6. 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

    Article  PubMed  Google Scholar 

  7. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484

    Article  PubMed  Google Scholar 

  8. Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G (2002) Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287:321–328

    Article  PubMed  Google Scholar 

  9. Bouchard A, Martel G, Sabri E, Schlachta CM, Poulin EC, Mamazza J, Boushey RP (2009) Does experience with laparoscopic colorectal surgery influence intraoperative outcomes? Surg Endosc 23:862–868

    Article  PubMed  Google Scholar 

  10. 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 discussion 1378-1379

    Article  PubMed  Google Scholar 

  11. Schlachta CM, Mamazza J, Seshadri PA, Cadeddu M, Poulin EC (2000) Determinants of outcomes in laparoscopic colorectal surgery: a multiple regression analysis of 416 resections. Surg Endosc 14:258–263

    Article  PubMed  CAS  Google Scholar 

  12. Black M, Gould JC (2006) Measuring laparoscopic operative skill in a video trainer. Surg Endosc 20:1069–1071

    Article  PubMed  CAS  Google Scholar 

  13. Derossis AM, Fried GM, Abrahamowicz M, Sigman HH, Barkun JS, Meakins JL (1998) Development of a model for training and evaluation of laparoscopic skills. Am J Surg 175:482–487

    Article  PubMed  CAS  Google Scholar 

  14. Pigazzi A, Anderson C, Mojica-Manosa P, Smith D, Hernandez K, Paz IB, Ellenhorn JD (2008) Impact of a full-time preceptor on the institutional outcome of laparoscopic colectomy. Surg Endosc 22:635–639

    Article  PubMed  Google Scholar 

  15. Seymour NE (2005) Integrating simulation into a busy residency program. Minim Invasive Ther Allied Technol 14:280–286

    Article  PubMed  Google Scholar 

  16. Poulin EC, Gagne JP, Boushey RP (2006) Advanced laparoscopic skills acquisition: the case of laparoscopic colorectal surgery. Surg Clin North Am 86:987–1004

    Article  PubMed  Google Scholar 

  17. Pappas TN, Jacobs DO (2004) Laparoscopic resection for colon cancer—the end of the beginning? N Engl J Med 350:2091–2092

    Article  PubMed  CAS  Google Scholar 

  18. Li JC, Hon SS, Ng SS, Lee JF, Yiu RY, Leung KL (2009) The learning curve for laparoscopic colectomy: experience of a surgical fellow in an university colorectal unit. Surg Endosc 23:1603–1608

    Article  PubMed  Google Scholar 

  19. 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

    Article  PubMed  Google Scholar 

  20. Beck DE (1994) Colorectal operative experience. Results of a survey. Dis Colon Rectum 37:905–908

    Article  PubMed  CAS  Google Scholar 

  21. Ritchie WP Jr, Rhodes RS, Biester TW (1999) Work loads and practice patterns of general surgeons in the United States, 1995–1997: a report from the American Board of Surgery. Ann Surg 230:533–542 discussion 542-533

    Article  PubMed  Google Scholar 

  22. Barleben A, Gandhi D, Nguyen XM, Che F, Nguyen NT, Mills S, Stamos MJ (2009) Is laparoscopic colon surgery appropriate in patients who have had previous abdominal surgery? Am Surg 75:1015–1019

    PubMed  Google Scholar 

  23. Fielding LP, Arsenault PA, Chapuis PH, Dent O, Gathright B, Hardcastle JD, Hermanek P, Jass JR, Newland RC (1991) Clinicopathological staging for colorectal cancer: an International Documentation System (IDS) and an International Comprehensive Anatomical Terminology (ICAT). J Gastroenterol Hepatol 6:325–344

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosures

Carissa Bailey, Michelle Metchikian, Dr. Yasir Akmal, Dr. Jeong-Heum Baek, and Dr. Alessio Pigazzi have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of General and Oncologic Surgery, City of Hope National Medical Center, Duarte, CA, 91010, USA

    Yasir Akmal, Carissa Bailey, Jeong-Heum Baek, Michelle Metchikian & Alessio Pigazzi

  2. Department of Surgery, Gachon University of Medicine & Science, Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Korea

    Jeong-Heum Baek

Authors
  1. Yasir Akmal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carissa Bailey
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeong-Heum Baek
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michelle Metchikian
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alessio Pigazzi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alessio Pigazzi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Akmal, Y., Bailey, C., Baek, JH. et al. Oncological outcomes of laparoscopic colon resection for cancer after implementation of a full-time preceptorship. Surg Endosc 25, 2967–2971 (2011). https://doi.org/10.1007/s00464-011-1654-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-011-1654-9

Keywords

Search

Navigation