Colorectal Dis. 2022 Jul 15. doi: 10.1111/codi.16266. Online ahead of print.
ABSTRACT
BACKGROUND: Learning curve of total mesorectal excision (TME) by minimally invasive surgery (MIS) beyond the competency phase has not been adequately reported with large numbers or using a statistical control limit. We aimed to study the learning curves of MIS TME in the proficiency phase.
METHODS: Risk-adjusted (RA) cumulative sum (CUSUM) and RA Bernoulli CUSUM charts were plotted for sequential MIS TME performed by a surgical team over 1000 cases. Surgical failure, a composite endpoint of conversions, ≥ grade IIIA complications, R1 resections and inadequate nodal yield was used to monitor the performance.
RESULTS: The risk-adjusted CUSUM detected an inflection point around the 600th operation. Two peaks were identified that could be traced back to probable causes for surgical failures. Similar inflection points were detected at 450th case for laparoscopic TME and 367th case for sphincter preservation. No single definite threshold point was noticed for robotic or abdominoperineal operations. At no point did the curves cross the safety threshold. Surgical failure probability reduced with increasing experience in the multivariate regression (OR – 0.899; p – 0.000). This association persisted irrespective of the surgical approach (laparoscopic vs robotic) or the type of operation (sphincter preservation vs abdominoperineal resection).
CONCLUSIONS: The learning curves for MIS TME did not cross the safety threshold beyond the competency phase. However, a 10% relative risk reduction in surgical failures was observed for every 100 cases operated.
PMID:35839321 | DOI:10.1111/codi.16266
