Learning Curve to Lymph Node Resection in Minimally Invasive Esophagectomy for Cancer

Dhamija, Ankit; Rosen, Joshua E.; Dhamija, Anish; Rothberg, Bonnie E. Gould; Kim, Anthony W.; Detterbeck, Frank C.; Boffa, Daniel J.

doi:10.1177/155698451400900405

Cited by 9 publications

(9 citation statements)

References 20 publications

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“…This could be due to the small sample size. For some authors, the learning curve to reach a plateau ranges between 15 and 20 cases, while other authors who worked with systematized cumulative measurement systems reported > 35 or 40 cases 8,[27][28][29][30][31] .…”

Section: Discussionmentioning

confidence: 99%

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Eventos adversos durante la esofagectomía mininvasiva en posición prona y su relación con la curva de aprendizaje

Hernández¹,

Horiuchi²,

Rivaletto³

et al. 2019

Rev Argent Cirug

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Background: Since the initial description of laparoscopic fundoplication in 1991 for the treatment of gastroesophageal reflux disease, different minimally invasive procedures have been developed until nowadays, when esophagectomy is performed using combined thoracoscopy and laparoscopy. Objective: The aim of our study is to analyze the adverse events of minimally invasive esophagectomy in prone position during the learning curve. Material and methods: Between November 2011 and June 2017, 36 patients underwent minimally invasive esophagectomy in prone position in the Hospital Interzonal General de Agudos (HIGA) San Martín and the Instituto de Diagnóstico de La Plata. Results: During the abdominal stage one patient presented coronary vessel injury. The complications occurring in the thoracic stage included lung injury (n =2), azygos arch injury (n = 1), thoracic duct dissection (n = 1), laryngeal recurrent nerve lesion (n = 1) and main stem bronchus injury (n = 1) during lymph node resection. Most of these complications occurred in the first 20 patients, while in the remaining 16 cases only lung injury occurred (p = 0.10) Conclusion: Minimally invasive esophagectomy in prone position is a feasible and safe procedure that can cause serious intraoperative complications due to its complexity. Although the results of our series did not show statistically significant differences, the number of adverse events during surgeries performed by the same team showed an important reduction associated with better training.

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Section: Discussionmentioning

confidence: 99%

“…Esto podría deberse al tamaño reducido de la muestra. Para algunos autores, los casos necesarios para alcanzar la meseta en la curva de aprendizaje oscilan entre 15 y 20; para otros, que trabajaron con sistemas de mediciones acumulativos y sistematizados, el número debe ser mayor de 35 o 40 8,[27][28][29][30][31] .…”

Section: Movilización Esofágicaunclassified

Eventos adversos durante la esofagectomía mininvasiva en posición prona y su relación con la curva de aprendizaje

Hernández¹,

Horiuchi²,

Rivaletto³

et al. 2019

Rev Argent Cirug

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“…The Cox proportion hazards model was used; the hazard ratios (HRs) were calculated, and these values are presented in Table 7. Table 6 The screening of the six clinical parameters Ankit Dhamija [17] reported the learning curve for lymph node resection in MIE for oesophageal cancer and suggested that the ability to dissect lymph nodes completely during MIE was affected by the surgeons' experience, which might accumulate over time; a significant increase in experience could be achieved after the first 25 cases. The number of dissections was regarded as an important measurement of lymphadenectomy, and different lymphadenectomy thresholds were proposed based on various scholars' findings.…”

Section: Survival Analysis and Cox Proportional Hazards Regression Anmentioning

confidence: 99%

“…The minimally invasive approach is performed via a distinct view of the surgical anatomy, and specialized surgical schemes and skills are required. Although learning curves and other parameters for lymph node dissection have been reported over the past few years [17][18][19][20] , systematic analyses of these learning curves, as well as the clinical indexes and survival outcomes, with more than 200 cases or long monitoring times, are still limited. From July 2010 to August 2016, 214 patients underwent MIE for oesophageal cancer and were followed up.…”

Section: Introductionmentioning

confidence: 99%

Learning Curve for Minimally Invasive Oesophagectomy of Esophageal Cancer and contrast with Open Oesophagectomy

Zhao

Zeng

Mou

et al. 2020

Preprint

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Purpose: Minimally invasive oesophagectomy is a technically demanding procedure; thus, the learning curve of this procedure should be explored. Then the relatively mature minimally invasive oesophagectomy procedure should be contrasted with the open procedure. Methods: 214 consecutive patients underwent minimally invasive oesophagectomy were retrospectively reviewed. To evaluate the development of thoracoscopic-laparoscopic oesophagectomy and compare the mature minimally invasive oesophagectomy and open oesophagectomy (OE), we comprehensively studied the clinical and surgical parameters. The cumulative sum (CUSUM) plot was used to study the learning curve for systemic lymphadenectomy. Cox proportional hazards regression analysis was performed to evaluate the clinical factors affecting survival. Results: The bleeding volume, operation time, and postoperative mortality within 3 months significantly decreased after 20 patients. The rise point for the lymph nodes dissection number was visually determined to be at patient 57 in the CUSUM plots. Patients who underwent relatively mature thoracoscopic-laparoscopic oesophagectomy had better surgical data and short-term benefits than patients who underwent an open procedure. Cox proportional hazards regression analysis showed that the maximum diameter of the tumour cross-sectional area and the number of positive nodes had a significant influence on survival. Conclusions: The short-term benefits of thoracoscopic-laparoscopic oesophagectomy were suggested. There was no evidence that it is associated with a significantly better prognosis for patients with oesophageal cancer.

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“…In addition, "a minimum of 10 MIE performed" is the criterion of participating surgeons; it is questionable of whether the surgeons had overcome the learning curve for MIE. If not, the overall effectiveness of the minimally invasive procedure is compromised (13,14), and the conclusions are not convincing.…”

mentioning

confidence: 99%

Oncological outcomes of the TIME trial in esophageal cancer: is it the era of minimally invasive esophagectomy?

Tan

Tang

2018

Ann. Transl. Med.

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Learning Curve to Lymph Node Resection in Minimally Invasive Esophagectomy for Cancer

Cited by 9 publications

References 20 publications

Eventos adversos durante la esofagectomía mininvasiva en posición prona y su relación con la curva de aprendizaje

Eventos adversos durante la esofagectomía mininvasiva en posición prona y su relación con la curva de aprendizaje

Learning Curve for Minimally Invasive Oesophagectomy of Esophageal Cancer and contrast with Open Oesophagectomy

Oncological outcomes of the TIME trial in esophageal cancer: is it the era of minimally invasive esophagectomy?

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