Introduction of laparoscopic low anterior resection for rectal cancer early during residency: a single institutional study on short-term outcomes

Ogiso, Satoshi; Yamaguchi, Takashi; Hata, Hiroyuki; Kuroyanagi, Hiroya; Sakai, Yoshiharu

doi:10.1007/s00464-010-1057-3

Cited by 16 publications

(7 citation statements)

References 29 publications

(39 reference statements)

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“…In keeping with our previous finding, operative time was longer when procedures were performed by trainees [18]. Pelvic space cannot be expanded by pneumoperitoneum, as can be done in the upper abdomen, and limited working space directly affects the difficulty of safe and quick access, required to optimize visibility and retraction.…”

Section: Discussionsupporting

confidence: 71%

Evaluation of factors affecting the difficulty of laparoscopic anterior resection for rectal cancer: “narrow pelvis” is not a contraindication

et al. 2010

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Maximum tumor diameter, BMI, operator experience, and tumor location can be used to predict the operative time required to complete laparoscopic anterior resection with DST anastomosis for rectal cancer, with no correlations between pelvic dimensions and operative time. The difficulty of the procedure was not related to patients' pelvic dimensions, which led us to conclude that "narrow pelvis" is not a contraindication for this surgery. Based on these results, we suggest that laparoscopic anterior resection should be performed by experienced surgeons in patients with large tumors, high BMI, and/or extraperitoneal rectal cancer.

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Section: Discussionsupporting

confidence: 71%

Evaluation of factors affecting the difficulty of laparoscopic anterior resection for rectal cancer: “narrow pelvis” is not a contraindication

et al. 2010

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“…Thirty-one studies reported no statistically significant differences between faculty and residents on a wide variety of outcomes including mortality, morbidity and length of stay [52,54,56-58,61,63,67-69,73-90,92-94]. Although patient outcomes were similar, 12 of these 31 studies did report a significantly longer operation time for residents [61,67,69,74,77,78,81,83,84,87-89]. Nine studies reported negative outcomes of residents' involvement in patient care [53,55,59,60,62,65,66,71,91].…”

Section: Resultsmentioning

confidence: 99%

A systematic review of the effects of residency training on patient outcomes

Leeuw

Lombarts

Arah

et al. 2012

BMC Med

137

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BackgroundResidents are vital to the clinical workforce of today and tomorrow. Although in training to become specialists, they also provide much of the daily patient care. Residency training aims to prepare residents to provide a high quality of care. It is essential to assess the patient outcome aspects of residency training, to evaluate the effect or impact of global investments made in training programs. Therefore, we conducted a systematic review to evaluate the effects of relevant aspects of residency training on patient outcomes.MethodsThe literature was searched from December 2004 to February 2011 using MEDLINE, Cochrane, Embase and the Education Resources Information Center databases with terms related to residency training and (post) graduate medical education and patient outcomes, including mortality, morbidity, complications, length of stay and patient satisfaction. Included studies evaluated the impact of residency training on patient outcomes.ResultsNinety-seven articles were included from 182 full-text articles of the initial 2,001 hits. All studies were of average or good quality and the majority had an observational study design. Ninety-six studies provided insight into the effect of 'the level of experience of residents' on patient outcomes during residency training. Within these studies, the start of the academic year was not without risk (five out of 19 studies), but individual progression of residents (seven studies) as well as progression through residency training (nine out of 10 studies) had a positive effect on patient outcomes. Compared with faculty, residents' care resulted mostly in similar patient outcomes when dedicated supervision and additional operation time were arranged for (34 out of 43 studies). After new, modified or improved training programs, patient outcomes remained unchanged or improved (16 out of 17 studies). Only one study focused on physicians' prior training site when assessing the quality of patient care. In this study, training programs were ranked by complication rates of their graduates, thus linking patient outcomes back to where physicians were trained.ConclusionsThe majority of studies included in this systematic review drew attention to the fact that patient care appears safe and of equal quality when delivered by residents. A minority of results pointed to some negative patient outcomes from the involvement of residents. Adequate supervision, room for extra operation time, and evaluation of and attention to the individual competence of residents throughout residency training could positively serve patient outcomes. Limited evidence is available on the effect of residency training on later practice. Both qualitative and quantitative research designs are needed to clarify which aspects of residency training best prepare doctors to deliver high quality care.

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“…The operative time for laparoscopic resection is influenced by a surgeon’s skills10,19 and different surgical procedures. Our current study selects patients who underwent laparoscopic APR for ultra-low rectal cancer (2 to 5 cm from anal verge).…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing Difficulty of Laparoscopic Abdominoperineal Resection for Ultra-Low Rectal Cancer

Jiang

et al. 2017

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Purpose:Our current study was conducted to identify patients’ anatomic, pathologic, and clinical factors to predict difficulty of performing laparoscopic abdominoperineal resection for ultra-low rectal cancer.Materials and Methods:Records of 117 consecutive patients with rectal cancer 2 to 5 cm from the anal verge were retrospectively reviewed. Using univariate and multivariate linear or logistic regression models, standardized operative time and blood loss, as well as postoperative morbidity were utilized as endpoints to screen patients’ multiple variables to predict operative difficulty.Results:Multivariate linear regression analysis showed body mass index (BMI) (estimate=0.07, P=0.0056), interspinous distance (estimate=−0.02, P=0.0011), tumor distance from anal verge (estimate=−0.17, P=0.0355), prior abdominal surgery (estimate=0.51, P=0.0180), preoperative chemoradiotherapy (estimate=0.67, P=0.0146), and concurrent diseases (hypertension and/or diabetes mellitus) (estimate=0.49, P=0.0122) are predictors for standardized operative time. Age (estimate=0.02, P=0.0208) and concurrent diseases (estimate=0.43, P=0.0476) were factors related to standardized blood loss. BMI (estimate=0.15, P=0.0472) was the only predictor for postoperative morbidity based on logistic regression analysis.Conclusions:Age, BMI, interspinous distance, tumor distance from anal verge, prior abdominal surgery, preoperative chemoradiotherapy, and concurrent diseases influence the difficulty of performing laparoscopic abdominoperineal resection for ultra-low rectal cancer. Standardized operative time allows researchers to amass samples by pooling data from all published studies, thus building reliable models to predict operative difficulty for clinical use.

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Introduction of laparoscopic low anterior resection for rectal cancer early during residency: a single institutional study on short-term outcomes

Abstract: Our systematic training program on LLAR for rectal cancer enables resident surgeons to perform this procedure safely early during residency, with acceptable short-term outcomes.

Cited by 16 publications

References 29 publications

Evaluation of factors affecting the difficulty of laparoscopic anterior resection for rectal cancer: “narrow pelvis” is not a contraindication

Evaluation of factors affecting the difficulty of laparoscopic anterior resection for rectal cancer: “narrow pelvis” is not a contraindication

A systematic review of the effects of residency training on patient outcomes

Factors Influencing Difficulty of Laparoscopic Abdominoperineal Resection for Ultra-Low Rectal Cancer

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