A unique approach to quantifying the changing workload and case mix in laparoscopic colorectal surgery

Shah, PR; Gupta, Vikas; Haray, P. N.

doi:10.1111/j.1463-1318.2009.02143.x

Cited by 6 publications

(7 citation statements)

References 16 publications

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“…However, they are still accruing data on long term oncological outcomes. Laparoscopic TME can be technically challenging and should be undertaken by experienced surgeons[12,20-22]. Caution should therefore be exercised when evaluating results of laparoscopic TME when the expertise of the surgeons has not been defined.…”

Section: Discussionmentioning

confidence: 99%

Value of multi-disciplinary input into laparoscopic management of rectal cancer - An observational study

Rao¹,

Peiris²,

Arif³

et al. 2017

WJGS

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AIMTo assess the impact of multi-disciplinary teams (MDTs) management in optimising the outcome for rectal cancers.METHODSWe undertook a retrospective review of a prospectively maintained database of patients with rectal cancers (defined as tumours ≤ 15 cm from anal verge) discussed at our MDT between Jan 2008 and Jan 2011. The data was validated against the national database to ensure completeness of dataset. The clinical course and follow-up data was validated using the institution’s electronic patient records. The data was analysed in terms of frequencies and percentages. Significance of any differences were analysed using χ2 test. A Kaplan-Meier analysis was performed for overall survival and disease free survival.RESULTSFollowing appropriate staging, one hundred and thirty-three patients were suitable for potentially curative resections. Seventy two (54%) were upper rectal cancer (URC) - tumour was > 6 cm from the anal verge and 61 (46%) were lower rectal cancers (LRC) - lower extent of the tumour was palpable ≤ 6 cm. Circumferential resection margin (CRM) appeared threatened on pre-operative MRI in 19/61 (31%) patients with LRC requiring neo-adjuvant therapy (NAT). Of the 133 resections, 118 (89%) were attempted laparoscopically (5% conversion rate). CRM was positive in 9 (6.7%) patients; Median lymph node harvest was 12 (2-37). Major complications occurred in 8 (6%) patients. Median follow-up was 53 mo (0-82). The 90-d mortality was 2 (1.5%). Over the follow-up period, disease related mortality was 11 (8.2%) and overall mortality was 39 (29.3%). Four (3%) patients had local recurrence and 22 (16.5%) patients had distant metastases.CONCLUSIONManagement of rectal cancers can be optimized with multi-disciplinary input to attain acceptable long-term oncological outcomes even when incorporating a laparoscopic approach to rectal cancer resection.

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Section: Discussionmentioning

confidence: 99%

Value of multi-disciplinary input into laparoscopic management of rectal cancer - An observational study

Rao¹,

Peiris²,

Arif³

et al. 2017

WJGS

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“…This has been observed in other studies as well, that with better experience surgeons tend to be more liberal in case selection without major changes in the outcome. [1617]…”

Section: Discussionmentioning

confidence: 99%

“…Similarly Shah et al . [1217] has observed that with increasing experience, in a progressive time phase there is an increasing work load score and case mix without increase in complications or conversion. The same observations are made in the current study as well.…”

Section: Discussionmentioning

confidence: 99%

Does case selection and outcome following laparoscopic colorectal resection change after initial learning curve? Analysis of 235 consecutive elective laparoscopic colorectal resections

et al. 2013

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INTRODUCTION:Laparoscopic colorectal surgery is being widely practiced with an excellent short-term and equal long-term results for colorectal diseases including cancer. However, it is widely believed that as the experience of the surgeon/unit improves the results get better. This study aims to assess the pattern of case selection and short-term results of laparoscopic colorectal surgery in a high volume centre in two different time frames.MATERIALS AND METHODS:This study was done from the prospective data of 265 elective laparoscopic colorectal resections performed in a single unit from December 2005 to April 2011. The group was subdivided into initial 132 patients (Group 1) from December 2005 to December 2008 and next 133 patients (Group 2) between December 2008 and April 2011 who underwent laparoscopic colorectal resections for cancer. The groups were compared for intraoperative and perioperative parameters, type of surgery, and the stage of the disease.RESULTS:The age of patients was similar in Groups 1 and 2 (57.7 and 56.9, respectively). Patients with co-morbid illness were significantly more in Group 2 than in Group 1 (63.2% vs. 32.5%, respectively, P≤0.001). There were significantly more cases of right colonic cancers in Group 1 than in Group 2 (21.9% vs. 11.3%, respectively, P<0.02) and less number of low rectal lesions (20.4% vs. 33.8%, respectively, P≤0.02). The conversion rates were 3.7% and 2.2% in Groups 1 and 2, respectively. The operating time and blood loss were significantly more in Group 1 than in Group 2. The ICU stay was significantly different in Groups 1 and 2 (31.2± 19.1 vs. 24.7± 18.7 h, P≤0.005). The time for removal of the nasogastric tube was significantly earlier (P=0.005) in Group 2 compared to Group 1 (1.37± 1.1 vs. 2.63±1.01 days). The time to pass first flatus, resumption of oral liquids, semisolid diet, and complications were similar in both groups. The hospital stay was more in Group 1 than in Group 2 ( P≤0.01). The numbers of lymph nodes retrieved was similar in both groups. The T stage of the disease in Groups 1 and 2 were similar, however, the number of T4 lesions was significantly more in Group 2 (8.3% vs. 18.7%, respectively, P<0.01).CONCLUSION:This study shows that with increasing experience, laparoscopic colorectal surgery can be practiced safely with minimal conversion rates and morbidity. As the units experience improves, there is a trend towards selecting advanced cases and performing complex laparoscopic colorectal procedures. With increasing experience, there is a trend towards better short-term outcome after laparoscopic colorectal surgeries.

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“…Attempts have been made previously to assess surgical difficulty through a survey of surgeons, but this remains a subjective assessment [11]. A previous study from our unit has shown that the IEV score can be used as an index of the difficulty of procedures [12]. The IEV scoring system, which was originally postulated as a marker for the operative workload [8], defined a standard primary inguinal hernia repair as an intermediate operation and scored it at 1 point.…”

Section: Discussionmentioning

confidence: 99%

A tool-kit for the quantitative assessment of proficiency in laparoscopic colorectal surgery

Shah

Haray

2011

Colorectal Disease

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A unique approach to quantifying the changing workload and case mix in laparoscopic colorectal surgery

Abstract: This article establishes a reliable and reproducible tool for quantifying the total laparoscopic colorectal workload of an individual surgeon or of an entire department, while at the same time providing a measure of the complexity of the case mix.

Cited by 6 publications

References 16 publications

Value of multi-disciplinary input into laparoscopic management of rectal cancer - An observational study

Value of multi-disciplinary input into laparoscopic management of rectal cancer - An observational study

Does case selection and outcome following laparoscopic colorectal resection change after initial learning curve? Analysis of 235 consecutive elective laparoscopic colorectal resections

A tool-kit for the quantitative assessment of proficiency in laparoscopic colorectal surgery

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