Fengming Xu1,2, Yiqiao Zhang1,2, Jiafu Yan3, Bowen Xu1,2, Guocong Wu1,2, Zhengyang Yang1,2, Liting Sun1,2, Xiao Zhang1,2, Hongwei Yao4,5, Zhongtao Zhang6,7. 1. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Rd, Xi-Cheng District, Beijing, 100050, China. 2. National Clinical Research Center for Digestive Diseases, 95 Yong-an Rd, Xi-Cheng District, 100050, Beijing, China. 3. Department of Cardiovascular Medicine, Beijing Anzhen Hospital, Capital Medical University, 2 An-zhen Rd, Chao-Yang District, Beijing, 100029, China. 4. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Rd, Xi-Cheng District, Beijing, 100050, China. yaohongwei@ccmu.edu.cn. 5. National Clinical Research Center for Digestive Diseases, 95 Yong-an Rd, Xi-Cheng District, 100050, Beijing, China. yaohongwei@ccmu.edu.cn. 6. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Rd, Xi-Cheng District, Beijing, 100050, China. zhangzht@ccmu.edu.cn. 7. National Clinical Research Center for Digestive Diseases, 95 Yong-an Rd, Xi-Cheng District, 100050, Beijing, China. zhangzht@ccmu.edu.cn.
Abstract
PURPOSE: As transanal total mesorectal excision (taTME) is performed worldwide, the optimization of existing training and guidance programs to enhance new taTME learners' competence in performing this procedure is warranted. This study aimed to evaluate the taTME learning curve in patients with mid-low rectal cancer. METHODS: Patients who underwent taTME for mid-low rectal cancer between October 2015 and August 2021 at a single center were included. A cumulative sum (CUSUM) learning curve analysis was performed with the total operation time as the study outcome. The learning curve was analyzed using risk-adjusted CUSUM analysis, with postoperative complications and anastomotic leakage (AL) as outcomes. RESULTS: In total, 104 consecutive patients were included in this study. The CUSUM learning curve for total operative time started declining after 42 cases (309.1 ± 84.4 vs. 220.2 ± 46.4, P < 0.001). The risk-adjusted CUSUM (RA-CUSUM) learning curve for postoperative complications fluctuated in cases 44-75 and declined significantly after case 75. The RA-CUSUM learning curve for AL declined after 68 cases. CONCLUSIONS: taTME had learning curves of 42, 75, and 68 cases for total operative time, postoperative complications, and AL, respectively. A surgeon may require 42 and 75 cases to achieve "proficiency" and "mastery" in taTME procedures, respectively.
PURPOSE: As transanal total mesorectal excision (taTME) is performed worldwide, the optimization of existing training and guidance programs to enhance new taTME learners' competence in performing this procedure is warranted. This study aimed to evaluate the taTME learning curve in patients with mid-low rectal cancer. METHODS: Patients who underwent taTME for mid-low rectal cancer between October 2015 and August 2021 at a single center were included. A cumulative sum (CUSUM) learning curve analysis was performed with the total operation time as the study outcome. The learning curve was analyzed using risk-adjusted CUSUM analysis, with postoperative complications and anastomotic leakage (AL) as outcomes. RESULTS: In total, 104 consecutive patients were included in this study. The CUSUM learning curve for total operative time started declining after 42 cases (309.1 ± 84.4 vs. 220.2 ± 46.4, P < 0.001). The risk-adjusted CUSUM (RA-CUSUM) learning curve for postoperative complications fluctuated in cases 44-75 and declined significantly after case 75. The RA-CUSUM learning curve for AL declined after 68 cases. CONCLUSIONS: taTME had learning curves of 42, 75, and 68 cases for total operative time, postoperative complications, and AL, respectively. A surgeon may require 42 and 75 cases to achieve "proficiency" and "mastery" in taTME procedures, respectively.
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