The Learning Curve of Laparoscopic Treatment of Rectal Cancer Does Not Increase Morbidity

Luján, Juan; González, A. Prieto; Abrisqueta, Jesús; Hernández, Quiteria; Valero, Graciela; Abellán, Israel; Frutos, María Dolores; Parrilla, Pascual

doi:10.1016/j.cireng.2013.03.008

Cited by 10 publications

(13 citation statements)

References 26 publications

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“…This surgery requires identification of tissue planes to avoid injuring the neighboring structures, such as the ureter, vagina and hypogastric plexus. An initial training period is necessary and repetition of the operation provides surgeons with the experience necessary to safely perform these complex and difficult procedures without increasing morbidity or mortality and compromising long-term oncologic results (19).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Oncologic Short Term Results of Laparoscopic Versus Open Surgery of Rectal Cancer

Maddah

Abdollahi

et al. 2015

Ann Colorectal Res

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Background: Today, with improvements in laparoscopy technique, surgery of rectal cancer is performed by laparoscopy. Objectives: This study was performed to evaluate oncologic results of open versus laparoscopic surgery of rectal cancer in terms of resection margins, removal of lymph nodes and recurrence rate. Patients and Methods: This descriptive-analytic study was performed on 88 patients with middle and lower rectal cancer in the two equivalent groups of laparoscopic and open surgery in Mashhad Ghaem and Omid hospitals during 2011 -2013. Information including age, sex, number of removed and involved lymph nodes, proximal, distal, and radial margins, tumor stage and location, recurrence and disease-free survival collected in the questionnaire and analyzed using descriptive statistics and frequency distribution tables and t-test. Results:Both groups of open and laparoscopic surgery had similar characteristics of age, sex, recurrence and disease-free survival, tumor margins and one-year mortality. The number of removed and involved lymph nodes was higher in the laparoscopic group (5.16 vs. 3.55, respectively, with P < 0.050, and 1.74 vs. 0.59 with P = 0.023), but the ratio of involved lymph nodes to the total number of removed lymph nodes was not different between the two groups (LNR) (P = 0.071). Tumor stage was higher in the laparoscopic group and most were in stages II and III (P < 0.001). Conclusions: Laparoscopic surgery is an effective technique for safe margin and removing lymph nodes in rectal cancer.

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Section: Discussionmentioning

confidence: 99%

Comparison of Oncologic Short Term Results of Laparoscopic Versus Open Surgery of Rectal Cancer

Maddah

Abdollahi

et al. 2015

Ann Colorectal Res

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“…Patients in both groups were operated for the same median number of lymph nodes. Median and quartile range of lymph nodes for group A were 20 (14-28), while for group B were 26 (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) showing no statistically signi cant differences (p = 0.145). Hospitalization days were not signi cantly different in both groups (p = 0.109) showing a median of 7 (5-8) for group A and 6 (5-7) for group B.…”

Section: Resultsmentioning

confidence: 94%

“…In other countries, the percentage of colorectal surgeries performed laparoscopically is much lower [13,14]. The main reason for that is the steep and long-term learning curve of laparoscopic colorectal surgery [15,16].…”

Section: Introductionmentioning

confidence: 99%

Multidimensional Analysis of the Learning Curve of Laparoscopic Colorectal Surgery in a Regional Hospital. The Implementation of a Standardised Surgical Procedure Counterbalances the Lack of Experience.

Gkionis

Flamourakis

Tsagkataki

et al. 2020

Preprint

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Background: Although in the last few years a larger proportion of colorectal surgeries have been performed laparoscopically, a steep learning curve prevents us from considering laparoscopic colorectal surgery as the gold standard technique for treating disease entities in the colon and rectum. The purpose of this single center study is to determine, using various parameters and following a well structured and standardised surgical procedure, the adequate number of cases after which a single surgeon qualified in open surgery but with no previous experience of laparoscopic colorectal surgery and without supervision, can acquire proficiency in this technique.Methods: From 2012 to 2019, 112 patients with pathology in the rectum and colon underwent a laparoscopic colorectal resection by a team led by the same surgeon. The patients were divided into two groups (Group A:50 – Group B:62) and their case records and histopathology reports were examined for predefined parameters, statistically analyzed and compared between groups.Results: There was no significant difference between groups in the distribution of conversions (p=0.635) and complications (p=0.637). Patients in both groups were operated for the same median number of lymph nodes (p=0.145) and stayed the same number of days in hospital (p=0.109). A statistically important difference was found in operation duration both in total (p=0.006) and for each different type of colectomy (sigmoidectomy: p=0.026, right colectomy: p=0.013, Extralevator abdominoperineal resection: p=0.050, low anterior resection: p=0.083).Conclusions: Taking into consideration all the parameters, it is our belief that a surgeon acquires proficiency in laparoscopic colorectal surgery after performing at least 50 diverse cases with a well structured and standardised surgical procedure.

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“…Furthermore, Lujan et al demonstrated that it was possible to complete the learning process without compromising patient safety or oncologic outcomes. 51 Interestingly, one study found that learning curves for robotic proctectomies were steeper than those of laparoscopic proctectomies after 41 cases, with acceptable perioperative outcomes. 52 We therefore think that it is crucial for a surgeon performing laparoscopy for rectal cancer to have undergone adequate training during residency and fellowship before independently operating on these patients.…”

Section: Challenges and Barriers To Implementationmentioning

confidence: 99%

Laparoscopy for Rectal Cancer

Atallah

Efron

2017

Clinics in Colon and Rectal Surgery

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It is evident that the use of laparoscopy in the management of rectal cancer has gained popularity in the last few years. It is still, however, not widely accepted as the standard of care. Multiple randomized trials have shown that short-term outcomes and perioperative morbidity and mortality of laparoscopic proctectomy are equivalent to open surgery. However, data regarding long-term oncologic outcomes are still scarce, with only a few randomized trials reporting similar outcomes in both laparoscopic and open group. A more recent trial failed to replicate those results in patients with locally advanced rectal cancer. In this article, we will look at the most recent evidence regarding the use of laparoscopy for patients with rectal cancer. We will also briefly discuss the different approaches and new minimally invasive techniques used in this field, and we will talk about the challenges facing the widespread adoption of laparoscopic surgery in the management of rectal cancer.

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The Learning Curve of Laparoscopic Treatment of Rectal Cancer Does Not Increase Morbidity

Cited by 10 publications

References 26 publications

Comparison of Oncologic Short Term Results of Laparoscopic Versus Open Surgery of Rectal Cancer

Comparison of Oncologic Short Term Results of Laparoscopic Versus Open Surgery of Rectal Cancer

Multidimensional Analysis of the Learning Curve of Laparoscopic Colorectal Surgery in a Regional Hospital. The Implementation of a Standardised Surgical Procedure Counterbalances the Lack of Experience.

Laparoscopy for Rectal Cancer

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