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Skill-qualified surgeons positively affect short-term outcomes after laparoscopic gastrectomy for gastric cancer: a survey of the National Clinical Database of Japan

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Abstract

Background

Proficiency of the operating surgeon is one of the most critical factors potentially associated with reductions in complications and surgery-related mortality. With video-rating systems having shown potential for assessing laparoscopic surgeons’ proficiency, the Endoscopic Surgical Skill Qualification System (ESSQS) was developed by the Japan Society for Endoscopic Surgery to subjectively assess the proficiency of laparoscopic surgeons by rating applicants’ non-edited case videos. We conducted a study to evaluate how ESSQS skill-qualified (SQ) surgeon involvement influences short-term outcomes of laparoscopic gastrectomy performed for gastric cancer.

Methods

Data from the National Clinical Database regarding laparoscopic distal and total gastrectomy performed for gastric cancer between January 2016 and December 2018 were analyzed. Operative mortality, defined as 30-day mortality or 90-day in-hospital mortality, and anastomotic leakage rates were compared per involvement vs. non-involvement of an SQ surgeon. Outcomes were also compared per involvement of a gastrectomy-, colectomy-, or cholecystectomy-qualified surgeon. The association between the area of qualification and operative mortality/anastomotic leakage was also analyzed with a generalized estimating equation logistic regression model used to account for patient-level risk factors and institutional differences.

Results

Of 104,093 laparoscopic distal gastrectomies, 52,143 were suitable for inclusion in the study; 30,366 (58.2%) were performed by an SQ surgeon. Of 43,978 laparoscopic total gastrectomies, 10,326 were suitable for inclusion; 6501 (63.0%) were performed by an SQ surgeon. Gastrectomy-qualified surgeons outperformed non-SQ surgeons in terms of both operative mortality and anastomotic leakage. They also outperformed cholecystectomy- and colectomy-qualified surgeons in terms of operative mortality or anastomotic leakage in distal and total gastrectomy, respectively.

Conclusion

The ESSQS appears to discriminate laparoscopic surgeons who can be expected to achieve significantly improved gastrectomy outcomes.

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Funding

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Author information

Authors and Affiliations

  1. Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan

    Takeyuki Misawa

  2. Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Hideki Endo & Hiroyuki Yamamoto

  3. Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan

    Toshiyuki Mori

  4. Department of Surgery, Tokyo Women’s Medical University, Tokyo, Japan

    Shigeki Yamaguchi

  5. Department of Gastroenterological and Pediatric Surgery, Oita University of Faculty of Medicine, Yufu, Oita, Japan

    Masafumi Inomata

  6. Department of Surgery, Red Cross Hospital Osaka, Osaka, Japan

    Yoshiharu Sakai

  7. Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

    Yoshihiro Kakeji

  8. Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan

    Hiroaki Miyata

  9. Department of Surgery, Keio University School of Medicine, Tokyo, Japan

    Yuko Kitagawa

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  1. Takeyuki Misawa
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Correspondence to Takeyuki Misawa.

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Disclosures

Drs. Hideki Endo and Hiroyuki Yamamoto, who are affiliated with the Department of Healthcare Quality Assessment, Graduate School of Medicine, the University of Tokyo, receive endowments from the National Clinical Database, Johnson & Johnson K.K., and Nipro Corporation. Dr. Hiroyuki Yamamoto has received consulting fees from Mitsubishi Tanabe Pharma Corporation; received honoraria for his lectures from Chugai Pharmaceutical Co., Ltd. and Ono Pharmaceutical Co., Ltd.; and received payment for writing a manuscript from Astellas Pharma, Inc. Dr. Yuko Kitagawa is affiliated with Keio University School of Medicine, which has received grants from Asahi Kasei Pharma Corporation, Ono Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Factory Inc., Nippon Covidien Inc., Taiho Pharmaceutical Co., Ltd., Chugai Pharmaceutical Co., Ltd., Kaken Pharmaceutical Co., Ltd., Yakult Honsha Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Tsumura & Co., Sumitomo Pharma Co., Ltd., EA Pharma Co., Ltd., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Medicon Inc., Takeda Pharmaceutical Co., Ltd., and Teijin Pharma Limited. Dr. Yuko Kitagawa has received honoraria from Chugai Pharmaceutical Co., Ltd., Taiho Pharmaceutical Co., Ltd., Asahi Kasei Pharma Corporation, Otsuka Pharmaceutical Factory Inc., Shionogi & Co., Ltd., Nippon Covidien Inc., Ethicon, Inc., Ono Pharmaceutical Co., Ltd., Olympus Corporation, Bristol-Myers Squibb K.K., AstraZeneca K.K., MSD K.K., Smith & Nephew K.K., Kaken Pharmaceutical Co., Ltd., ASKA Pharmaceutical Co., Ltd., Miyarisan Pharmaceutical Co., Ltd., Toray Industries, Inc., Daiichi Sankyo Company, Limited, Chugai Foundation for Innovative Drug Discovery Science, Nippon Kayaku Co., Ltd., EA Pharma Co., Ltd., Intuitive Surgical G.K., and Takeda Pharmaceutical Co., Ltd. Dr. Hiroaki Miyata has received provision of materials from the National Clinical Database, Johnson & Johnson K.K., Nipro Corporation, and Intuitive Surgical Sàrl. Dr. Masafumi Inomata has received honoraria from Olympus Co. Ltd., Medtronic Co. Ltd., and Johnson & Johnson K.K. Drs. Takeyuki Misawa, Toshiyuki Mori, Shigeki Yamaguchi, Yoshiharu Sakai, and Yoshihiro Kakeji have no conflicts of interest or financial ties to disclose.

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Misawa, T., Endo, H., Mori, T. et al. Skill-qualified surgeons positively affect short-term outcomes after laparoscopic gastrectomy for gastric cancer: a survey of the National Clinical Database of Japan. Surg Endosc 37, 4627–4640 (2023). https://doi.org/10.1007/s00464-023-09950-7

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