Proficiency in bariatric surgery may shorten the learning curve for minimally-invasive D2 gastrectomy.

IF 2.1 3区 医学 Q2 SURGERY Langenbeck's Archives of Surgery Pub Date : 2024-10-08 DOI:10.1007/s00423-024-03485-8
Sven Flemming, Lars Kollmann, Anna Widder, Joy Backhaus, Johan Friso Lock, Felix Nickel, Alexander Wierlemann, Armin Wiegering, Christoph-Thomas Germer, Florian Seyfried
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引用次数: 0

Abstract

Introduction: Evidence from Asian studies suggests that minimally-invasive gastrectomy achieves equivalent oncological but improved perioperative outcomes compared to open surgery. Oncological gastric resections are less frequent in European countries. Index procedures may play a role for the learning curve of minimally-invasive gastrectomy. The aim of our study was to evaluate if skills acquired in bariatric surgery allow a safe and oncologically adequate implementation of minimally-invasive gastrectomy in a cohort of european patients.

Methods: In this single-center retrospective study, all patients who received primary bariatric surgery between January 2015 and December 2018 and minimally-invasive surgery for gastric cancer treated from June 2019 to January 2023 were evaluated. Primary endpoints were operation time, lymph node yield and lymph node fractions. Secondary endpoints included postoperative complications and oncological outcomes.

Results: Learning curves for two surgeons with 350 bariatric procedures and 44 minimally-invasive gastrectomies were analyzed. For bariatric surgery, the mean operation time decreased from initially 82 ± 27 to 45 ± 21 min and 118 ± 28 to 81 ± 36 min for sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), while the complication rate remained within the international benchmark. For laparoscopic gastrectomy (n = 30), operation times decreased but then remained stable over time. Operation times for the robotic platform were longer (302 ± 60 vs. 390 ± 48 min; p < 0.001) with the learning curve remaining incomplete after 14 procedures. R0 status was achieved in 95.5% of patients; the mean number of lymph nodes retrieved was 37 ± 14 with no differences between the groups. Complete mesogastric excision was more frequently achieved during the later laparoscopic cases whereas it occurred earlier for the robotic group (p = 0.004). Perioperative morbidity was comparable to the European benchmark. Textbook outcome was achieved in 54.4% of the cases.

Conclusion: In summary, we could demonstrate a successful skill transfer from bariatric surgery to minimally-invasive laparoscopic oncological gastric surgery enabling safe and oncologically adequate minimally-invasive D2 gastrectomy in a central European patient collective.

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熟练掌握减肥手术可缩短微创 D2 胃切除术的学习曲线。
导言:来自亚洲的研究证据表明,微创胃切除术与开腹手术相比,不仅取得了同等的肿瘤治疗效果,而且改善了围手术期的治疗效果。在欧洲国家,肿瘤性胃切除术并不常见。索引手术可能会影响微创胃切除术的学习曲线。我们研究的目的是评估在减肥手术中获得的技能是否能在欧洲患者群中安全、充分地实施肿瘤微创胃切除术:在这项单中心回顾性研究中,对2015年1月至2018年12月期间接受初级减肥手术以及2019年6月至2023年1月期间接受胃癌微创手术治疗的所有患者进行了评估。主要终点为手术时间、淋巴结产量和淋巴结分数。次要终点包括术后并发症和肿瘤结果:分析了两名外科医生 350 例减肥手术和 44 例微创胃切除术的学习曲线。在减肥手术方面,袖带胃切除术(SG)和Roux-en-Y胃旁路术(RYGB)的平均手术时间分别从最初的82±27分钟和118±28分钟降至45±21分钟和81±36分钟,而并发症发生率仍保持在国际基准范围内。腹腔镜胃切除术(n = 30)的手术时间有所缩短,但随后保持稳定。机器人平台的手术时间更长(302±60 分钟 vs. 390±48 分钟;P 结论:在腹腔镜胃切除术中,并发症发生率保持在国际基准范围内:总之,我们展示了从减肥手术到微创腹腔镜肿瘤胃手术的成功技能转移,在中欧患者群体中实现了安全、肿瘤学充分的微创 D2 胃切除术。
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来源期刊
CiteScore
3.30
自引率
8.70%
发文量
342
审稿时长
4-8 weeks
期刊介绍: Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.
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