Learning curve for standardized laparoscopic surgery for colorectal cancer under supervision: a single-center experience

Abstract

Background: Laparoscopic resection for colorectal cancer is increasingly being performed worldwide. Although learning standardized procedures under the supervision of an experienced surgeon may be effective, there is currently no information on the learning curve under such circumstances. This single-center study aimed to evaluate the learning curve for laparoscopic resection for colorectal cancer of one surgical fellow with no previous experience with laparoscopic colectomy.

Methods: Data were analyzed for 108 consecutive patients who underwent laparoscopic resection for colorectal cancer between July 2007 and October 2009. Surgery was performed by a single fellow with no prior experience with laparoscopic colorectal resection. The learning effect was evaluated by dividing the patients into two groups: group 1 consisted of the first 50 patients and group 2 included the last 58 patients. Short-term outcomes were compared between groups.

Results: More complex procedures were performed more frequently in group 2 than in group 1 (p=0.0086). A significantly greater percentage of cases was completed by the trainee in group 2 than in group 1 (91% vs. 68%; p=0.0030) and were performed independent of the supervisor (81% vs. 38%; p<0.0001). All procedures after the 65th case were completed by the trainee. Mean number of lymph nodes harvested (15 vs. 16), conversion to open surgery (0% vs. 2%), and postoperative complications (4% vs. 12%) did not differ significantly between groups. There were no intraoperative complications or mortality. Operating time for sigmoidectomy/high anterior resection reached a steady state after 35 cases.

Conclusions: The present study shows that training in laparoscopic surgery for colorectal cancer under the supervision of an experienced surgeon can be performed safely without jeopardizing the short-term outcomes. More complex procedures were performed successfully by the trainee during the later period, even though he was more independent of the supervisor.