Effect of the Endoscopic Surgical Skill Qualification System for Colorectal Cancer Surgery With Multivisceral Resection on Long-term Outcomes: Japanese Multicenter Analysis

Abstract

Background/aim: Reportedly, in laparoscopic surgeries for colorectal cancer, surgeries performed or supervised by Endoscopic Surgery Skills Qualification System (ESSQS)-certified surgeons yield favorable outcomes. However, the impact of ESSQS-certification on the prognosis of multivisceral resection (MVR) surgery remains unclear. The aim of this study was to examine the impact of MVR surgery performed by ESSQS-qualified surgeons on patient prognosis.

Patients and methods: We retrospectively reviewed 226 consecutive colorectal cancer patients who underwent MVR between 2016 and 2024. The patients were divided into two groups: surgery performed by ESSQS-certified surgeons (expert group, n=88) and those performed by ESSQS-uncertified surgeons (non-expert group, n=138). Propensity score matching for baseline patient and surgical characteristics identified 65 patients in each group. Groups were compared for clinicopathological and surgical features, and 5-year relapse-free survival (RFS), overall survival (OS) and local recurrence free survival (LRFS) were assessed using Kaplan Meier methods and log-rank tests.

Results: Before matching, the incidence of rectal cancer was higher (33.0% vs. 8.7%, p<0.001) and laparoscopic surgery was more often performed (89.8% vs. 79.7%, p=0.043) in the expert group. Five-year RFS (74.8% vs. 63.1%, p=0.056), OS (83.3% vs. 64.4%, p=0.062), and LRFS (3.5% vs. 11.4%, p=0.078) tended to be better in the expert group.

Conclusion: The results of this multicenter study indicated better short- and long-term outcomes of MVR performed by ESSQS-qualified surgeons.

Keywords: Japanese Endoscopic Surgical Skill Qualification System; long-term outcome; multivisceral resection.