Two-Stage Indicators to Assess Learning Curves for Minimally Invasive Ivor Lewis Esophagectomy

Wang, Qi; Wu, Zixiang; Chen, Gang; Zhang, Sai; Shen, Gang; Wu, Ming

doi:10.1055/s-0036-1593408

Cited by 8 publications

(6 citation statements)

References 28 publications

(39 reference statements)

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“…The learning curve can decrease the prognosis both in the short and long term. This might be a particular concern for complex minimally invasive techniques including oesophagectomy and other procedures. Thus, the findings here are not sufficient to recommend minimally invasive oesophagectomy as standard of care.…”

Section: Discussionmentioning

confidence: 78%

Meta-analysis of health-related quality of life after minimally invasive versus open oesophagectomy for oesophageal cancer

Kauppila

Xie

Johar

et al. 2017

British Journal of Surgery

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Background The aim of this systematic review and meta‐analysis was to compare health‐related quality of life (HRQoL) outcomes between minimally invasive and open oesophagectomy for cancer at different postoperative time points. Methods A search of PubMed (MEDLINE), Web of Science, Embase, Scopus, CINAHL and the Cochrane Library was performed for studies that compared open with minimally invasive oesophagectomy. A random‐effects meta‐analysis was conducted for studies that measured HRQoL scores using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ‐C30 and QLQ‐OES18 questionnaires. Mean differences (MDs) greater than 10 in scores were considered clinically relevant. Pooled effects of MDs with 95 per cent confidence intervals were estimated to assess statistical significance. Results Nine studies were included in the qualitative analysis, involving 1157 patients who had minimally invasive surgery and 907 patients who underwent open surgery. Minimally invasive surgery resulted in better scores for global quality of life (MD 11·61, 95 per cent c.i. 3·84 to 19·39), physical function (MD 11·88, 3·92 to 19·84), fatigue (MD −13·18, −17·59 to −8·76) and pain (MD −15·85, −20·45 to −11·24) compared with open surgery at 3 months after surgery. At 6 and 12 months, no significant differences remained. Conclusion Patients report better global quality of life, physical function, fatigue and pain 3 months after minimally invasive surgery compared with open surgery. No such differences remain at longer follow‐up of 6 and 12 months.

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Section: Discussionmentioning

confidence: 78%

Meta-analysis of health-related quality of life after minimally invasive versus open oesophagectomy for oesophageal cancer

Kauppila

Xie

Johar

et al. 2017

British Journal of Surgery

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“…In particular, although the percentage of anastomotic leakages was relatively high (16%) in the present study, it is still comparable with that of some referral centers worldwide with wide experience in minimally invasive esophagectomy (15–21%) . In fact, apart from the influence of the learning curve and the difficulties associated with the development of a dedicated program for minimally invasive esophageal surgery, the observed rate of anastomotic leakage seems to be stable for the different experiences . This is consistent with our experience, in which the EP and the LP did not differ significantly on surgical outcomes, with particular reference to anastomotic leak and morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, the new platform features an overhead, four‐arm robot that does not require redocking the system and enables easier passages from the thoracic to the abdominal surgical field . Finally, the availability of a second console is crucial in enhancing a dedicated program of esophageal surgery, which is of paramount importance to improve surgical outcomes . The possibility of a simultaneous proctoring on the same surgical field provides fellows and young surgeons with the possibility to proceed toward progressively more challenging steps of the whole procedure under the continuous guidance of an experienced surgeon.…”

Section: Discussionmentioning

confidence: 99%

Early experience with totally robotic esophagectomy for malignancy. Surgical and oncological outcomes

Guerra

Vegni

Gia

et al. 2018

Robotics Computer Surgery

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“…Most reports have used intraoperative variables, such as operative time (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), but other reports have also used clinically more relevant outcome parameters, such as postoperative complications and anastomotic leakage (13,14,19). Regarding analysis methods, most studies assigned patients to arbitrarily created groups and compared outcomes of patients operated on early after implementation between patients operated on later (9,11,(20)(21)(22)(23)(24)(25)(26)(27).…”

Section: Learning Curve Of Miementioning

confidence: 99%

Learning curve and postoperative outcomes of minimally invasive esophagectomy

Claassen¹,

Workum²,

Rosman³

2019

J. Thorac. Dis

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Surgical innovation is necessary to increase surgical effectiveness and to decrease postoperative complications, but can be associated with learning curves. The significance of surgical learning curves is increasing and it is important to take surgical learning curves into account when interpreting outcome data that is acquired during an implementation period. This may especially be the case for a technically challenging procedure like minimally invasive esophagectomy (MIE). This review article provides an overview of the published literature that has described a learning curve for MIE, with particular interest in the relationship between the learning curve and postoperative complications. Twenty two studies reported learning curves of different types of MIE. These studies showed that the length of the learning curve of MIE can be significant, but most studies are single center studies of limited methodological quality. In addition, several learning curve analysis methods are used but a clear recommendation regarding the preferred method is lacking. Most studies use intraoperative parameters (e.g., operative time) to define the length of the learning curve. However, significant learning curve effects have been found for clinically more relevant parameters (e.g., anastomotic leak), especially for Ivor Lewis MIE. These studies suggest that patient safety can be substantially compromised during learning curves. To increase patient safety and shorten the learning curve, evidence based and effective safe implementation programs are necessary.

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Two-Stage Indicators to Assess Learning Curves for Minimally Invasive Ivor Lewis Esophagectomy

Cited by 8 publications

References 28 publications

Meta-analysis of health-related quality of life after minimally invasive versus open oesophagectomy for oesophageal cancer

Meta-analysis of health-related quality of life after minimally invasive versus open oesophagectomy for oesophageal cancer

Early experience with totally robotic esophagectomy for malignancy. Surgical and oncological outcomes

Learning curve and postoperative outcomes of minimally invasive esophagectomy

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