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Learning process analysis of robotic lateral pelvic lymph node dissection for local advanced rectal cancer: the CUSUM curve of 78 consecutive patients

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Abstract

Purpose

Robotic lateral lymph node dissection (LLND) has been described as a safe and feasible procedure for local advanced rectal cancer. The aim of this study was to evaluate the learning curve for robotic-assisted LLND.

Methods

We collected data on 78 consecutive patients who underwent robotic-LLND at our hospital. The learning curve was analyzed using the cumulative sum (CUSUM) method to assess changes in the unilateral LLND operative times across the case sequence.

Results

Among the 78 patients, 52 underwent bilateral LLND and 26 underwent unilateral LLND. A total of 130 consecutive data were recorded. We arranged unilateral robotic-LLND operative times and calculated cumulative sum values, allowing the differentiation of three phases: phase I (learning period, cases 1–51); phase II (proficiency period, cases 52–83); and phase III (mastery period, cases 84–130). As the learning curve accumulated, the operation time and estimated blood loss of unilateral robotic-LLND decreased significantly with each phase (P < 0.05). By 12 months after surgery, the International Prostatic Symptom Score of patients at phase III was significantly lower than at phase I (P < 0.05).

Conclusion

The CUSUM curve shows three phases in the learning of robotic-LLND. The estimated learning curve for robotic-assisted rectal-LLND is achieved after 51 cases.

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Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

nCRT:

Neoadjuvant chemoradiotherapy

TME:

Total mesorectal excision

LR:

Local recurrence

LLND:

Lateral lymph node dissection

CUSUM:

Cumulative sum

CT:

Computed tomography

MRI:

Magnetic resonance imaging

LLNs:

Lateral lymph nodes

IPSS:

International Prostatic Symptom Score

OS:

Overall survival

RFS:

Relapse-free survival

ASA:

American Society of Anesthesiologist

BMI:

Body mass index

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Funding

This project was supported by the National Natural Science Foundation of China (No. 81870380) and Shaanxi Province Science Foundation (2023-GHYB-13).

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Author notes

  1. Lei Zhang and Chenhao Hu have contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Road, Xi’an, Shaanxi, China

    Lei Zhang, Chenhao Hu, Qian Qin, Ruizhe Li, Jiamian Zhao, Zhe Zhang, Zhe Wang, Junjun She & Feiyu Shi

  2. Center for Gut Microbiome Research, Med-X Institute, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China

    Lei Zhang, Chenhao Hu, Qian Qin, Ruizhe Li, Jiamian Zhao, Zhe Zhang, Zhe Wang, Junjun She & Feiyu Shi

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  1. Lei Zhang
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  2. Chenhao Hu
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Contributions

LZ was responsible for the design of the study, statistical analysis, and drafting and revising of the manuscript; CH was involved in the design of the study and provided critical comments and review of the manuscript; CH, QQ, RL, JZ, ZZ, and ZW provided critical comments and review of the manuscript; JS and FS designed and supervised the study and revised the manuscript. All authors have read and approved the final version of the manuscript.

Corresponding authors

Correspondence to Junjun She or Feiyu Shi.

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Conflict of interest

We have no conflicts of interest to declare.

Ethical approval

This study was approved by the Ethics Committee of the First Affiliated Hospital of Xi’an Jiaotong University (No. 2019ZD04).

Informed consent

This was obtained from all participants in the study.

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Zhang, L., Hu, C., Qin, Q. et al. Learning process analysis of robotic lateral pelvic lymph node dissection for local advanced rectal cancer: the CUSUM curve of 78 consecutive patients. Surg Today 54, 220–230 (2024). https://doi.org/10.1007/s00595-023-02725-6

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  • DOI: https://doi.org/10.1007/s00595-023-02725-6

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