Clinical impact of Endoscopic Surgical Skill Qualification System (ESSQS) by Japan Society for Endoscopic Surgery (JSES) for laparoscopic distal gastrectomy and low anterior resection based on the National Clinical Database (NCD) registry

Abstract

Aim This study aimed to evaluate the association between surgeons certified via the Endoscopic Surgical Skill Qualification System (ESSQS) of the Japan Society for Endoscopic Surgery (JSES) and surgical outcomes of laparoscopic distal gastrectomy (LDG) and laparoscopic low anterior resection (LLAR). Methods Japanese National Clinical Database data on the patients undergoing LDG and LLAR between 2014‐2016 were analyzed retrospectively. The proportion of cases performed by ESSQS‐certified surgeons was calculated for each procedure, and clinicopathological factors with or without participation of ESSQS‐certified surgeons as an operator were assessed. Then, effects of operations performed by ESSQS‐certified surgeons on short‐term patient outcomes were analyzed using generalized estimating equations logistic regression analysis. Results There were 110 610 and 65 717 patients who underwent LDG and LLAR, respectively. The operations performed by ESSQS‐certified surgeons in each procedure totaled 28 467 (35.3%) and 12 866 (31.2%), respectively. A multivariable logistic regression model showed that odds ratios of mortality for LDG and LLAR performed by ESSQS‐certified surgeons were 0.774 (95% CI, 0.566‐1.060, P = 0.108) and 0.977 (0.591‐1.301, P = 0.514), respectively. Odds ratios for secondary endpoints of anastomotic leakage in LDG and LLAR performed by ESSQS‐certified surgeons were 0.835 (95% CI, 0.723‐0.964, P = 0.014) and 0.929 (0.860‐1.003, P = 0.059), respectively, whereas that of ileus/bowel obstruction for LLAR performed by ESSQS‐certified surgeons was 1.265 (1.132‐1.415, P < 0.001). There were no significant associations between the two operations performed by ESSQS‐certified surgeons and other factors such as mortality and overall complications. Conclusions ESSQS certification did not affect postoperative mortality following LDG and LLAR, but annual experience of laparoscopic surgery was associated with it. ESSQS certification may contribute to favorable outcomes regarding anastomotic leakage following LDG and LLAR.

Surgical outcomes in gastroenterological surgery in Japan: Report of the National Clinical Database 2011–2019

“…The importance of board‐certified surgeons was reported in RHC 36 and PD 37 . The Endoscopic Surgical Skill Qualification System certification by the Japan Society for Endoscopic Surgery did not affect the postoperative mortality following laparoscopic DG and LAR 38 . Additionally, hospital volume affected postoperative mortality after TG 39 and PD, 40 and laparoscopic liver resection was safely developed with a low mortality and complication rate relative to open liver resection in Japan 41 .…”

“… 37 The Endoscopic Surgical Skill Qualification System certification by the Japan Society for Endoscopic Surgery did not affect the postoperative mortality following laparoscopic DG and LAR. 38 Additionally, hospital volume affected postoperative mortality after TG 39 and PD, 40 and laparoscopic liver resection was safely developed with a low mortality and complication rate relative to open liver resection in Japan. 41 A geriatric surgery pilot study was conducted from 2017 to 2020, and the specific variables and outcome predictors in geriatric surgery were implemented in the NCD system in 2021.…”

Clinical impact of the triple‐layered circular stapler for reducing the anastomotic leakage in rectal cancer surgery: Porcine model and multicenter retrospective cohort analysis

“…All patients, except those with bowel obstruction, underwent mechanical bowel preparation with magnesium citrate and sennoside on the day before surgery. Surgical procedures were performed or supervised by expert colorectal surgeons qualified by the Endoscopic Surgical Skill Qualification System of Japan, 15 each of whom had performed more than 200 laparoscopic colorectal operations.…”

Laparoscopic surgical skill evaluation with motion capture and eyeglass gaze cameras: A pilot study

“…7 The Japanese Society for Endoscopic Surgery (JSES) has established a technically certified doctor system since 2004, 21 and certified surgeons are known to be highly skilled and their patients have fewer surgical complications. 22 Three of the subjects in this study were certified surgeons, all of whom had more experience of having performed more than 200 laparoscopic procedures. In addition, although one surgeon was not certified as a specialist, this person had experience of more than 400 cases and was considered to have excellent technical skill.…”