Accreditation as a qualified surgeon improves surgical outcomes in laparoscopic distal gastrectomy

Kikuchi, Shinichi; Kagawa, Tetsuya; Kuroda, Shigetoshi; Nishizaki, Masahiko; Takata, Nobuo; Kuwada, Kazuya; Shoji, Ryohei; Kakiuchi, Yoshihiko; Mitsuhashi, Toshiharu; Umeda, Yuzo; Noma, Kazuhiro; Kagawa, Shunsuke; Fujiwara, Toshiyoshi

doi:10.1007/s00595-021-02309-2

Cited by 7 publications

(4 citation statements)

References 24 publications

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“…To achieve this, the participating surgeons were required to have ESSQS certification, which was established in 2004 to maintain laparoscopic technical skills, a standardized laparoscopic surgery process. Recent studies have shown that ESSQS-certified surgeons were more likely to deliver favorable LADG outcomes . Furthermore, we performed a central review of D2 LND quality by assessing close-up photographs of the operative field after dissection, which benefited surgical quality assessment …”

Section: Discussionmentioning

confidence: 99%

Five-Year Survival Outcomes of Laparoscopy-Assisted vs Open Distal Gastrectomy for Advanced Gastric Cancer

et al. 2023

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ImportanceEvidence of implementation of laparoscopic gastrectomy for locally advanced gastric cancer is currently insufficient, as the primary end point in previous prospective studies was evaluated at a median follow-up time of 3 years. More robust evidence is necessary to verify noninferiority of laparoscopic gastrectomy.ObjectiveTo compare 5-year survival outcomes between laparoscopy-assisted distal gastrectomy (LADG) and open distal gastrectomy (ODG) with D2 lymph node dissection for locally advanced gastric cancer.Design, Setting, and ParticipantsThis was a multicenter, open-label, noninferiority, prospective randomized clinical trial. Between November 26, 2009, and July 29, 2016, eligible patients with histologically proven gastric carcinoma from 37 institutes in Japan were enrolled. Two interim analyses and final analysis were performed in October 2014, May 2018, and November 2021, respectively.InterventionsPatients were randomly assigned (1:1) to either the ODG or LADG group. The procedures were performed exclusively by qualified surgeons.Main Outcomes and MeasuresThe primary end point was 5-year relapse-free survival, and the noninferiority margin for the hazard ratio (HR) was set at 1.31. The secondary end points were 5-year overall survival and safety.ResultsA total of 502 patients were included in the full-analysis set: 254 (50.6%) in the ODG group and 248 (49.4%) in the LADG group. Patients in the ODG group had a median (IQR) age of 67 (33-80) years and included 168 males (66.1%). Patients in the LADG group had a median (IQR) age of 64 (34-80) years and included 169 males (68.1%). No significant differences were observed in severe postoperative complications between the 2 groups in the safety analysis (ODG, 4.7% [11 of 233] vs LADG, 3.5% [8 of 227]; P = .64). The median (IQR) follow-up for all patients after randomization was 67.9 (60.3-92.0) months. The 5-year relapse-free survival was 73.9% (95% CI, 68.7%-79.5%) and 75.7% (95% CI, 70.5%-81.2%) for the ODG and LADG groups, respectively, and the HR was 0.96 (90% CI, 0.72-1.26; noninferiority 1-sided P = .03). Further, no significant difference was observed in overall survival time between the 2 groups, and the HR was 0.83 (95% CI, 0.57-1.21; P = .34). The pattern of recurrence was similar between the 2 groups.Conclusions and RelevanceResults of this study show that on the basis of 5-year follow-up data, LADG with D2 lymph node dissection for locally advanced gastric cancer, when performed by qualified surgeons, was proved noninferior to ODG. This laparoscopic approach could become a standard treatment for locally advanced gastric cancer.Trial RegistrationUMIN Clinical Trial Registry: UMIN000003420

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Section: Discussionmentioning

confidence: 99%

Five-Year Survival Outcomes of Laparoscopy-Assisted vs Open Distal Gastrectomy for Advanced Gastric Cancer

et al. 2023

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“…Despite the existence of several systems to assess the proficiency of residents and trainers, no previous experience was published assessing the safety and efficacy of a surgical procedure. The system accredited less than 50% of the surgeons who applied at the beginning [ 66 ] but the effects of this selection, even if highly debated, produced an improvement in surgical outcomes [ 67 – 69 ]. A recent paper published by Mori et al [ 70 ] showed that in the context of acute cholecystitis, the qualified surgeons outperformed their colleagues in terms of 30 and 90-day mortality.…”

Section: Resultsmentioning

confidence: 99%

Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper

et al. 2023

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Background Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, is widely adopted in elective digestive surgery, but selectively used for surgical emergencies. The present position paper summarizes the available evidence concerning the learning curve to achieve proficiency in emergency MIS and provides five expert opinion statements, which may form the basis for developing standardized curricula and training programs in emergency MIS. Methods This position paper was conducted according to the World Society of Emergency Surgery methodology. A steering committee and an international expert panel were involved in the critical appraisal of the literature and the development of the consensus statements. Results Thirteen studies regarding the learning curve in emergency MIS were selected. All but one study considered laparoscopic appendectomy. Only one study reported on emergency robotic surgery. In most of the studies, proficiency was achieved after an average of 30 procedures (range: 20–107) depending on the initial surgeon’s experience. High heterogeneity was noted in the way the learning curve was assessed. The experts claim that further studies investigating learning curve processes in emergency MIS are needed. The emergency surgeon curriculum should include a progressive and adequate training based on simulation, supervised clinical practice (proctoring), and surgical fellowships. The results should be evaluated by adopting a credentialing system to ensure quality standards. Surgical proficiency should be maintained with a minimum caseload and constantly evaluated. Moreover, the training process should involve the entire surgical team to facilitate the surgeon’s proficiency. Conclusions Limited evidence exists concerning the learning process in laparoscopic and robotic emergency surgery. The proposed statements should be seen as a preliminary guide for the surgical community while stressing the need for further research.

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“…Furthermore, they were more commonly involved as a supervisor than as an attending physician or surgeon. In recent years, several studies investigating the involvement of board-certi ed surgeons in surgery and their effect on improving prognosis have been published in Japan [14,15]. Kobayashi et al previously reported that the involvement of a board-certi ed gastroenterological surgeon from the Japanese Society of Gastroenterological Surgery and a boardcerti ed colorectal surgeon from the Japan Society of Coloproctology contributed to the reduction of mortality in individuals undergoing right hemicolectomy of the colon [16].…”

Section: Discussionmentioning

confidence: 99%

Involvement of acute care surgeons reduces post-surgery complications: A propensity-score matched evaluation of clinical outcomes

Ogawa,

Komori,

Tajiri

et al. 2023

Preprint

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Purpose: Acute care surgeons are experts in trauma treatment, emergency surgery, and critical surgical care. Herein, we analyzed the impact of involvement of an acute care surgeon vs a general surgeon on postoperative outcomes in emergency general surgery. Methods: This retrospective study included 92 patients who underwent emergency general surgery at our institution between January 2020 and September 2021. Patients were separated into two groups based on the attending surgeon, and propensity score matching was used to analyze postoperative outcomes. The primary outcome was postoperative complications, while secondary outcomes included perioperative management and surgery-related and postoperative complications. Logistic regression analysis was applied to estimate the odds ratios (OR) for all complications. Results: Overall, 30 patients were treated by acute care surgeons (ACS group) and 62 patients were treated by general surgeons (non-ACS group). Propensity score matching identified 30 patients with balanced baseline covariates in each group. After matching, the ACS group had lower complication rates (Clavien–Dindo classification ≥2) than the non-ACS group (17% vs. 40%, P=0.08), as well as a significantly shorter surgery duration (75 min vs. 96 min, P=0.014). In logistic analysis, acute care surgeon involvement was identified as an independent predictor for a decrease in all complications (OR, 0.15; 95%CI, 0.02–0.64). Conclusion: Acute care surgeon involvement reduces the overall complication rate in emergency general surgery.

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Accreditation as a qualified surgeon improves surgical outcomes in laparoscopic distal gastrectomy

Cited by 7 publications

References 24 publications

Five-Year Survival Outcomes of Laparoscopy-Assisted vs Open Distal Gastrectomy for Advanced Gastric Cancer

Five-Year Survival Outcomes of Laparoscopy-Assisted vs Open Distal Gastrectomy for Advanced Gastric Cancer

Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper

Involvement of acute care surgeons reduces post-surgery complications: A propensity-score matched evaluation of clinical outcomes

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