Learning curve analysis for prophylactic bilateral robot-assisted lateral lymph node dissection for lower rectal cancer: a retrospective study.

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Techniques in Coloproctology Pub Date : 2025-03-07 DOI:10.1007/s10151-025-03119-1

T Sueda, M Yasui, J Nishimura, Y Kagawa, M Kitakaze, R Mori, C Matsuda, Y Ushimaru, T Sugase, Y Mukai, H Komatsu, Y Yanagimoto, T Kanemura, K Yamamoto, H Wada, K Goto, H Miyata, M Ohue

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Abstract

Background: Lateral lymph node dissection (LLND) is an important surgical procedure in the treatment of lower rectal cancer (RC). However, limited data are available regarding the learning curve for robot-assisted LLND (RA-LLND). This study aimed to evaluate the learning curve for prophylactic bilateral RA-LLND for lower RC.

Methods: We retrospectively analyzed 58 consecutive patients with clinical stage II/III lower RC who had undergone prophylactic bilateral RA-LLND between July 2020 and June 2024. Cumulative sum (CUSUM) analysis was used to evaluate the learning curve for bilateral RA-LLND operative time.

Results: The mean age of patients was 61.5 years, and mean body mass index was 23.4 kg/m². The proportion of neoadjuvant therapy was 8.6%. Mean prophylactic bilateral RA-LLND operative time was 173.7 min. CUSUM analysis divided the learning curve for prophylactic bilateral RA-LLND operative time into three phases: initial learning phase (20 cases); competence phase (16 cases); and master/proficiency phase (subsequent cases). Mastery of surgical technique was achieved after performing the 36th case. Comparisons of surgical outcomes in terms of operative parameters and complications were made between phases 1 and 2 combined and phase 3. A significant reduction in mean prophylactic bilateral RA-LLND operative time was observed between phases 1 and 2 compared with phase 3 (P < 0.01). Mean blood loss was decreased in phase 3 (40.5 ml) compared to phases 1 and 2 combined (148.2 ml, P < 0.01). The frequencies of overall postoperative complications directly related to LLND and urinary dysfunction were significantly reduced in phase 3 compared to phases 1 and 2 combined (P = 0.04, and P = 0.02, respectively).

Conclusions: The three phases identified by CUSUM analysis represented characteristics of the learning curve for prophylactic bilateral RA-LLND. These data suggest that 20 cases are required for the early stage of the learning curve, whereas mastery level could be achieved after 36 cases.

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预防性双侧机器人辅助下直肠癌侧淋巴结清扫的学习曲线分析：一项回顾性研究。

背景：侧淋巴结清扫术（LLND）是治疗下段直肠癌（RC）的重要手术方法。然而，关于机器人辅助LLND （RA-LLND）的学习曲线的数据有限。本研究旨在评估预防性双侧RA-LLND的学习曲线。方法：我们回顾性分析了在2020年7月至2024年6月期间接受预防性双侧RA-LLND的58例临床II/III期下RC患者。采用累积和（CUSUM）分析评估双侧RA-LLND手术时间的学习曲线。结果：患者平均年龄61.5岁，平均体重指数23.4 kg/m2。新辅助治疗比例为8.6%。双侧RA-LLND预防性手术时间平均为173.7 min。CUSUM分析将双侧RA-LLND预防性手术时间学习曲线分为3个阶段：初始学习阶段（20例）；能力阶段（16例）；和掌握/熟练阶段（后续案例）。完成第36例手术后，熟练掌握了手术技术。比较1期、2期联合手术与3期手术的手术参数及并发症。与第3期相比，第1期和第2期的平均预防性双侧RA-LLND手术时间显着减少(P)结论：CUSUM分析确定的三个阶段代表了预防性双侧RA-LLND的学习曲线特征。这些数据表明，学习曲线的早期阶段需要20例，而36例后即可达到精通水平。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.