Challenges and Learning Curves in Adopting TaTME and Robotic Surgery for Rectal Cancer: A Cusum Analysis

Planellas, Pere; Cornejo, Lídia; Pigem, Anna; Gómez-Romeu, Núria; Julià-Berkgvist, David; Ortega, Nuria; Rodríguez-Hermosa, José Ignacio; Farrés, Ramón

doi:10.3390/cancers14205089

Cited by 6 publications

(6 citation statements)

References 40 publications

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“…In general, they are close to similar or TaTME learning curve is longer (7,16,17,28). Studies suggest the rate of anastomotic leakage and urological lesions could be higher in TaTME, but the rate of conversion could be higher in RoTME (29). Structured training pathway, including specialization, long training periods, accumulation of experience and proctoring, is important in shortening the learning curve for difficult procedures (7,30).…”

Section: Discussion Discussionmentioning

confidence: 55%

Learning Curve of Robotic Total Mesorectal Excision versus Transanal Total Mesorectal Excision - A Single-Center Study

Karamanliev¹,

Yotsov²,

Dimitrov³

2023

SGO

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Introduction: Rectal cancer treatment has changed over the last several decades. Total mesorectal excision (TME) has proven to be the gold standard in rectal cancer surgery. Transanal total mesorectal excision (TaTME) and robotic total mesorectal excision (RoTME) for low and mid rectal cancer are implemented to overcome some of the difficulties of the laparoscopic approach. The aim of this study is to show a single-center experience in the learning curves of both RoTME and TaTME. Material and methods: A single-center prospective study comparing the first 17 consecutive RoTME cases from January 2016 to May 2019 to the first 16 consecutive cases of TaTME from July 2019 to June 2021 was conducted. The difference in the time periods is due to the later implementation of TaTME in the center. All procedures were performed by a single team. Results: A total of 33 patients were included in the study -17 RoTME patients and 16 TaTME patients. The groups were homogeneously distributed in terms of patients' characteristics and stage. Comparing the two groups, no statistically significant differences between them were found in terms of complication rates (p=0.692), positive circumferential resection margins rates (p=0.000), frequency of anastomotic leak rates (p=0.596), time from completion of radiotherapy to surgery (p=0.229) and time from surgery to ileostomy closure (p=0.880). A statistically significant shorter operative time was found in the TaTME group (p=0.008). Conclusion:The learning curve should be considered in all procedures. A structured training pathway for TaTME and RoTME is essential. No differences between robTME and TaTME in the learning curve were observed in our center.

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Section: Discussion Discussionmentioning

confidence: 55%

Learning Curve of Robotic Total Mesorectal Excision versus Transanal Total Mesorectal Excision - A Single-Center Study

Karamanliev¹,

Yotsov²,

Dimitrov³

2023

SGO

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“…It is performed by summing the events by cumulation, which can detect minor deviations in the outcome of interest—in our case, operative time (OT) 23 . We analyzed OT using the CUSUM analysis by applying the following formula:

CUSU{M}_{OTn}=\sum _{i=1}^{n}xi-\mu ,

where xi is the surgical time used for each case, µ is the mean surgical time, and I indicated the case number 24 . The study population could be divided into learning (group 1) and a plateau (group 2) phase by estimating the CUSUM score of OT throughout the study period.…”

Section: Methodsmentioning

confidence: 99%

“…where xi is the surgical time used for each case, µ is the mean surgical time, and I indicated the case number. 24 The study population could…”

Section: Statisticsmentioning

confidence: 99%

Surgical efficacy and learning curves of laparoscopic complete mesocolic excision with intracorporeal anastomosis for right‐sided colon cancer: A retrospective two‐center cohort study

Cuk

Simonsen

Sherzai

et al. 2023

Journal of Surgical Oncology

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Background There is a potential benefit on long‐term outcomes following complete mesocolic excision (CME) for right‐sided colon cancer when compared to conventional colectomy. This study aims to analyze the learning curve and short‐term outcomes of laparoscopic CME with intracorporeal anastomosis (ICA) for right‐sided colon cancer in the hands of experienced colorectal surgeons. Methods A two‐center cohort study of consecutive patients undergoing right‐sided colectomy from September 2021 to May 2022 at two tertiary colorectal centers in Denmark. Learning curves of surgical time were estimated using a cumulative sum analysis (CUSUM). Results A total of 61 patients were included. According to the CUSUM analysis, 32 cases were needed to obtain a peak in operative time, resulting in a decrease in time consumption (group 1/learning phase: 217.2 min [SD 53.6] and group 2/plateau phase 191.6 min [SD 45.1], p = 0.05). There was a nonsignificant reduction in the rates of severe surgical complications (Clavien–Dindo > 3) (13% vs. 7%, p = 0.67) between the two groups, while the length of hospital stay remained constant (median 3.0 days, interquartile range, IQR [2.0; 4.0]). Conclusion The learning curve of laparoscopic CME with ICA for right‐sided colon cancer demonstrated that 32 cases were needed to obtain a plateau phase expressed by operative time.

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“…The learning curve of TaTME seems to be steeper than other techniques with around 60 cases for major complications reduction, 70 cases for operative time reduction, and 25-30 cases for anastomotic leak reduction (3,4). Data show no major difference between TaTME and robotic total mesorectal excision (rTME) (5).…”

Section: Introduction Introductionmentioning

confidence: 99%

Quality of Life after Transanal Total Mesorectal Excision - A Single-Center Study

Karamanliev

2023

SGO

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Introduction: Transanal total mesorectal excision (TaTME) has been used as a surgical technique for rectal cancer treatment for over a decade now. The bottom-up dissection provides a better view of the pelvic sensory nerve fibers, which theoretically could lead to better nerve preservation, hence better functional outcomes. Nevertheless, concerns about worsening of the functional results due to low anastomosis and sphincter damage caused by the platform have been raised. There is no clear data showing advantage or disadvantage of TaTME compared to robotic total mesorectal excision (rTME) or laparoscopic TME in terms of functional results. This study aims to present single-center data on quality of life (QoL) after TaTME. Material and Methods: A single-center prospective study on the quality of life after the first 16 consecutive cases of TaTME from July 2019 to June 2021 was conducted. Quality of life (QoL) was assessed with a questionnaire. A total of 13 patients were analyzed by EuroQol-5D (EQ-5D), EORTC QLQ-C30, EORTC QLQ-CR29, IPSS, LARS and Vaizey scores 1-9. Quality of Life data collection was done according to the following algorithm: (a) In patients without a stoma -preoperatively, at 3, 6, and 12 months, and annually thereafter; (b) in patients with a stoma -preoperatively, at 3 months postoperatively (if there was no stoma reversal), and after stoma reversal at 3, 6, and 12 months, and annually thereafter. All procedures were performed by the same team. Results: A total of 13 patients completed the questionnaires preoperatively and at least once postoperatively. Statistically significant improvement was found in the following parameters postoperatively compared with preoperative levels: EuroQol-5D pain/discomfort (p=0.014); physical functioning (p=0.046), financial problems (p=0.025); global health in QLQ-C30 (p=0.001), degree of anxiety/depression in QLQ-CR29 (p=0.020), specific quality of life in the IPSS questionnaire (p=0.011). No statistical differences were found in: the visual analogue self-reported health scale in EuroQol-5D (p=0.114); social functioning in the QLQ-C30 (p=0.705); fecal incontinence for patients without a stoma in QLQ-CR29 (p=0.317); degree of LARS (p=0.763); Vaziey score (p=0.782). Conclusion: quality of life after TaTME seems promising, large, well-structured trials in the scientific area are needed.

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Challenges and Learning Curves in Adopting TaTME and Robotic Surgery for Rectal Cancer: A Cusum Analysis

Cited by 6 publications

References 40 publications

Learning Curve of Robotic Total Mesorectal Excision versus Transanal Total Mesorectal Excision - A Single-Center Study

Learning Curve of Robotic Total Mesorectal Excision versus Transanal Total Mesorectal Excision - A Single-Center Study

Surgical efficacy and learning curves of laparoscopic complete mesocolic excision with intracorporeal anastomosis for right‐sided colon cancer: A retrospective two‐center cohort study

Quality of Life after Transanal Total Mesorectal Excision - A Single-Center Study

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