Cumulative sum analysis of the learning curve for laparoscopic complete mesocolic excision with central vascular ligation for right sided colon cancer

Yıl: 2022 Cilt: 47 Sayı: 3 Sayfa Aralığı: 1359 - 1365 Metin Dili: İngilizce DOI: 10.17826/cumj.1162953 İndeks Tarihi: 20-09-2022

Cumulative sum analysis of the learning curve for laparoscopic complete mesocolic excision with central vascular ligation for right sided colon cancer

Öz:
Purpose: Every procedure, no matter how difficult, has a learning curve. However, no one discusses the learning curve for simple operations. This idea constantly comes up when there is a demanding surgical method that challenges habits. The aim of this study is to use cumulative sum analysis to estimate the learning curve of the demanding laparoscopic complete mesocolic excision+central vascular ligation technique for right sided colon cancer. Materials and Methods: This retrospective study involved patients older than 18 years and with right-sided colon cancer admitted to Ankara University School of Medicine, Department of General Surgery between January 2015 and June 2022. The cumulative sum (CUSUM) chart based on operation duration and quantity of lymph nodes harvested was utilized to determine the learning curve. Results: 53 patients included in this study. CUSUM analysis based on operation duration showed that Surgeon had passed the learning phase and was considered proficient after 21 cases. And the CUSUM analysis based on the lymph nodes harvested revealed that surgeon gained proficiency in 25th case. In terms of demographic, oncological, and operative data, there was no difference between the the groups defined by the phases according to the CUSUM analysis based on both operation duration and lymph node count. Conclusion: Surgeons can become familiar with laparoscopic complete mesocolic excision for right sided colon cancer and perform it after approximately 21 to 25 operations.
Anahtar Kelime: complete mesocolic excision laparoscopy CUSUM Learning curve

Sağ kolon tümörlerinde laparoskopik komplet mezokolik eksizyon ve santral vasküler ligasyon öğrenme eğrisi için kümülatif toplam analizi

Öz:
Amaç: Her prosedürün, ne kadar zor olursa olsun, bir öğrenme eğrisi vardır. Ancak, hiç kimse basit işlemler için öğrenme eğrisinden bahsetmez. Bu kavram alışkanlıklara meydan okuyan zorlu bir cerrahi yöntem söz konusu olduğunda karşımıza çıkar. Bu çalışmanın amacı, sağ taraflı kolon kanseri için zorlayıcı bir yöntem olan laparoskopik komplet mezokolik eksizyon ve santral vasküler ligasyon tekniğinin kümülatif toplam analizi ile öğrenme eğrisinin belirlenmesidir. Gereç ve Yöntem: Bu retrospektif çalışmada Ocak 2015-Haziran 2022 tarihleri arasında Ankara Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı'na başvuran 18 yaşından büyük sağ kolon kanserli hastalar dahil edilmiştir. Ameliyat süresi ve lenf nodu miktarına göre kümülatif toplam (CUSUM) analizi kullanılarak öğrenme eğrisi belirlenmiştir. Bulgular: 53 hasta çalışmaya dahil edildi. Operasyon süresine göre yapılan CUSUM analizi, cerrahın 21 vakadan sonra öğrenme aşamasını geçtiğini ve yeterlik kazandığını göstermiştir. Lenf nodlarına göre yapılan CUSUM analizi ise cerrahın 25. vakada yeterlik kazandığını ortaya koymuştur. CUSUM analizlerine göre yeterlik öncesi ve sorası fazlardaki hastaların karşılaştırılmasında demografik, onkolojik ve operasyonel veriler açısından fark bulunamamıştır. Sonuç: Cerrahlar sağ kolon kanseri için laparoskopik komplet mezokolik eksizyon prosedürünü yaklaşık 21 ile 25 vaka sonrasında rahatlıkla yapabilirler.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Heald RJ. The “Holy Plane” of rectal surgery. J R Soc Med. 1988;81:503–8.
  • 2. West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P. Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol. 2010;28:272–8.
  • 3. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: Complete mesocolic excision and central ligation - Technical notes and outcome. Colorectal Dis. 2009;11:354–64.
  • 4. Koh FH, Tan KK. Complete mesocolic excision for colon cancer: Is it worth it? J Gastrointest Oncol. 2019;10:1215–21.
  • 5. Subramonian K, Muir G. The “learning curve” in surgery: what is it, how do we measure it and can we influence it? BJU Int. 2004;93:1173–4.
  • 6. Kutlu B, Benlice C, Kocaay F, Gungor Y, Ismail E, Akyol C et al. Computer based multimodal training module facilitates standardization of complete mesocolic excision technique for right sided colon cancer: Long term oncological outcomes. Colorectal Dis. 2021;23:3141–51.
  • 7. De’Angelis N, Lizzi V, Azoulay D, Brunetti F. Robotic versus laparoscopic right colectomy for colon cancer: Analysis of the initial simultaneous learning curve of a surgical fellow. J Laparoendosc Adv Surg Tech. 2016;26:882–92.
  • 8. Giani A, Veronesi V, Bertoglio CL, Mazzola M, Bernasconi DP, Grimaldi S, et al. Multidimensional evaluation of the learning curve for laparoscopic complete mesocolic excision for right colon cancer: a risk-adjusted cumulative summation analysis. Colorectal Dis. 2022;24:577–86.
  • 9. Koc MA, Celik SU, Guner V, Akyol C. Laparoscopic vs open complete mesocolic excision with central vascular ligation for right-sided colon cancer. Medicine (Baltimore). 2021;100:e24613.
  • 10. Jessup J, Goldberg R, Aware E, Al. E. Colon and rectum. In AJCC Cancer Staging Manual. 8th ed. (Ed M Amin, S Edge, FL Greene, DR Bryd, RK Borookland, MK Washington et al.):251. Cham, Springer, 2017.
  • 11. Valsamis EM, Chouari T, O’Dowd-Booth C, Rogers B, Ricketts D. Learning curves in surgery: Variables, analysis and applications. Postgrad Med J. 2018;94:525–30.
  • 12. Park JS, Ahn HK, Na J, Lee HH, Yoon YE, Yoon MG et al. Cumulative sum analysis of the learning curve for video-assistedminilaparotomy donor nephrectomy in healthy kidney donors. Medicine (Baltimore). 2018;97: e0560.
  • 13. Engledow AH, Thiruppathy K, Arulampalam T, Motson RW. Training in laparoscopic colorectal surgery – experience of training in a specialist unit. Ann R Coll Surg Engl. 2010;92:395-7.
  • 14. Cook’ JA, Ramsay’ CR, Fayersb P. Statistical evaluation of learning curve effects in surgical trials background learning curve effects. Clinical Trials. 2004;1:421-7.
  • 15. Odermatt M, Ahmed J, Panteleimonitis S, Khan J, Amjad Parvaiz. Prior experience in laparoscopic rectal surgery can minimise the learning curve for robotic rectal resections: a cumulative sum analysis. 2017;31:4067–76.
APA KOÇ M (2022). Cumulative sum analysis of the learning curve for laparoscopic complete mesocolic excision with central vascular ligation for right sided colon cancer. , 1359 - 1365. 10.17826/cumj.1162953
Chicago KOÇ MEHMET ALI Cumulative sum analysis of the learning curve for laparoscopic complete mesocolic excision with central vascular ligation for right sided colon cancer. (2022): 1359 - 1365. 10.17826/cumj.1162953
MLA KOÇ MEHMET ALI Cumulative sum analysis of the learning curve for laparoscopic complete mesocolic excision with central vascular ligation for right sided colon cancer. , 2022, ss.1359 - 1365. 10.17826/cumj.1162953
AMA KOÇ M Cumulative sum analysis of the learning curve for laparoscopic complete mesocolic excision with central vascular ligation for right sided colon cancer. . 2022; 1359 - 1365. 10.17826/cumj.1162953
Vancouver KOÇ M Cumulative sum analysis of the learning curve for laparoscopic complete mesocolic excision with central vascular ligation for right sided colon cancer. . 2022; 1359 - 1365. 10.17826/cumj.1162953
IEEE KOÇ M "Cumulative sum analysis of the learning curve for laparoscopic complete mesocolic excision with central vascular ligation for right sided colon cancer." , ss.1359 - 1365, 2022. 10.17826/cumj.1162953
ISNAD KOÇ, MEHMET ALI. "Cumulative sum analysis of the learning curve for laparoscopic complete mesocolic excision with central vascular ligation for right sided colon cancer". (2022), 1359-1365. https://doi.org/10.17826/cumj.1162953
APA KOÇ M (2022). Cumulative sum analysis of the learning curve for laparoscopic complete mesocolic excision with central vascular ligation for right sided colon cancer. Cukurova Medical Journal, 47(3), 1359 - 1365. 10.17826/cumj.1162953
Chicago KOÇ MEHMET ALI Cumulative sum analysis of the learning curve for laparoscopic complete mesocolic excision with central vascular ligation for right sided colon cancer. Cukurova Medical Journal 47, no.3 (2022): 1359 - 1365. 10.17826/cumj.1162953
MLA KOÇ MEHMET ALI Cumulative sum analysis of the learning curve for laparoscopic complete mesocolic excision with central vascular ligation for right sided colon cancer. Cukurova Medical Journal, vol.47, no.3, 2022, ss.1359 - 1365. 10.17826/cumj.1162953
AMA KOÇ M Cumulative sum analysis of the learning curve for laparoscopic complete mesocolic excision with central vascular ligation for right sided colon cancer. Cukurova Medical Journal. 2022; 47(3): 1359 - 1365. 10.17826/cumj.1162953
Vancouver KOÇ M Cumulative sum analysis of the learning curve for laparoscopic complete mesocolic excision with central vascular ligation for right sided colon cancer. Cukurova Medical Journal. 2022; 47(3): 1359 - 1365. 10.17826/cumj.1162953
IEEE KOÇ M "Cumulative sum analysis of the learning curve for laparoscopic complete mesocolic excision with central vascular ligation for right sided colon cancer." Cukurova Medical Journal, 47, ss.1359 - 1365, 2022. 10.17826/cumj.1162953
ISNAD KOÇ, MEHMET ALI. "Cumulative sum analysis of the learning curve for laparoscopic complete mesocolic excision with central vascular ligation for right sided colon cancer". Cukurova Medical Journal 47/3 (2022), 1359-1365. https://doi.org/10.17826/cumj.1162953