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Can better surgical outcomes be obtained in the learning process of robotic rectal cancer surgery? A propensity score-matched comparison between learning phases

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Abstract

Background

Although studies of robotic rectal cancer surgery have demonstrated the effects of learning on operation time, comparisons have failed to demonstrate differences in clinicopathological outcomes between unadjusted learning phases. This study aimed to investigate the learning curve of robotic rectal cancer surgery for clinicopathological outcomes and compare surgical outcomes between adjusted learning phases.

Study design

We enrolled 506 consecutive patients with rectal adenocarcinoma who underwent robotic resection by a single surgeon between 2007 and 2018. Risk-adjusted cumulative sum (RA-CUSUM) for surgical failure was used to analyze the learning curve. Surgical failure was defined as the occurrence of any of the following: conversion to open surgery, severe complications (Clavien–Dindo grade ≥ 3a), insufficient number of harvested lymph nodes (LNs), or R1 resection. Comparisons between learning phases analyzed by RA-CUSUM were performed before and after propensity score matching.

Results

In RA-CUSUM analysis, the learning curve was divided into two learning phases: phase 1 (1st–177th cases, n = 177) and phase 2 (178th–506th cases, n = 329). Before matching, patients in phase 2 had deeper tumor invasion and higher rates of positive LNs on pretreatment images and preoperative chemoradiotherapy. After matching, phase 1 (n = 150) and phase 2 (n = 150) patients exhibited similar clinical characteristics. Phase 2 patients had lower rates of surgical failure overall and these components: conversion to open surgery, severe complications, and insufficient harvested LNs.

Conclusions

For robotic rectal cancer surgery, surgical outcomes improved after the 177th case. Further studies by other robotic surgeons are required to validate our results.

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Acknowledgments

The authors thank Youn Ho Roh, a biostatistician, for methodological advice regarding the RA-CUSUM analysis used in this study.

Funding

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Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Korea

    Jong Min Lee, Seung Yoon Yang, Yoon Dae Han, Min Soo Cho, Hyuk Hur, Byung Soh Min, Kang Young Lee & Nam Kyu Kim

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  1. Jong Min Lee
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Contributions

JML, NKK: Conception and design. JML: Collection and assembly of data. JML, SYY, YDH, MSC, HH, BSM, KYL: Data analysis and interpretation. All authors: Manuscript writing. All authors: Final approval of manuscript.

Corresponding author

Correspondence to Nam Kyu Kim.

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Discloures

Dr. Jong Min Lee, Dr. Seung Yoon Yang, Dr. Yoon Dae Han, Dr. Min Soo Cho, Dr. Hyuk Hur, Dr. Byung Soh Min, Dr. Kang Young Lee and Dr. Nam Kyu Kim have no conflicts of interest or financial ties to disclose.

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464_2020_7445_MOESM1_ESM.tif

Supplementary file1 Supplementary Figure 1. Cumulative sum (CUSUM) for operation time. CUSUM peaked at the 133th case.(TIF 4332 kb)

Supplementary file2 (DOCX 15 kb)

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Lee, J.M., Yang, S.Y., Han, Y.D. et al. Can better surgical outcomes be obtained in the learning process of robotic rectal cancer surgery? A propensity score-matched comparison between learning phases. Surg Endosc 35, 770–778 (2021). https://doi.org/10.1007/s00464-020-07445-3

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  • DOI: https://doi.org/10.1007/s00464-020-07445-3

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