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. 2021 Nov;35(11):6251-6258.
doi: 10.1007/s00464-020-08125-y. Epub 2020 Oct 30.

Does staged surgical training for minimally invasive esophagectomy have an impact on short-term outcomes?

Koshiro Ishiyama  1   2 , Takeo Fujita  3 , Hisashi Fujiwara  3 , Daisuke Kurita  1 , Junya Oguma  1 , Hitoshi Katai  4 , Hiroyuki Daiko  5
Affiliations

Does staged surgical training for minimally invasive esophagectomy have an impact on short-term outcomes?

Koshiro Ishiyama et al. Surg Endosc. 2021 Nov.

Abstract

Background: sophageal cancer has a low incidence, and the anatomy is difficult to understand during esophagectomy. This necessitates a precise and lengthy operation. Therefore, the establishment of a training system in esophageal surgery is of critical importance. In this study, we compared the short-term outcomes of minimally invasive esophagectomy (MIE) performed by consultants versus trainees and explored the factors that impacted the thoracic operation time for each group.

Methods: We have introduced standardized MIE surgical techniques to our trainees in 2016. Our procedure consists of a laparoscopic phase and a thoracoscopic phase and is systematically designed to be learned in a step-by-step manner in each phase. We retrospectively identified 308 patients who underwent MIE from April 2016 to April 2018. The patients were divided into those who underwent MIE by consultants and those who underwent MIE by trainees. The preoperative background factors, operation-related factors, and postoperative complications were compared between the two groups. We also assessed the association between a prolonged thoracic operation time and tumor-and patient-related factors in each of the consults and trainees.

Results: Significantly more patients had stage ≥ III cancer in the consultant than trainee group. However, the postoperative complications were comparable, specifically pneumonia (11% vs. 18%), anastomotic leakage (11% vs. 13%), and mortality (0.6% vs. 1.3%). There was no significant difference in the lymph node yield (20 vs. 17) or R0 resection rate (94% vs. 91%) between the two groups. However, the trainees had a significantly longer thoracic operation time (143 ± 34 vs. 190 ± 28 min) and significantly greater blood loss (93 vs. 183 ml). Oncological factors were correlated with a prolonged thoracic operation time in the consultants, but not in the trainees.

Conclusions: Under standardized surgical management using a stepwise educational program, performance of MIE by trainees has no impact on short-term outcomes.

Keywords: Complication; Esophageal cancer; Minimally invasive esophagectomy; Surgical training.

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