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Impact of technically qualified surgeons on laparoscopic colorectal resection outcomes : results of a propensity score-matching analysis

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Title: Impact of technically qualified surgeons on laparoscopic colorectal resection outcomes : results of a propensity score-matching analysis
Authors: Ichikawa, N. Browse this author
Homma, S. Browse this author
Funakoshi, T. Browse this author
Ohshima, T. Browse this author
Hirose, K. Browse this author
Yamada, K. Browse this author
Nakamoto, H. Browse this author
Kazui, K. Browse this author
Yokota, R. Browse this author
Honma, T. Browse this author
Maeda, Y. Browse this author
Yoshida, T. Browse this author
Ishikawa, T. Browse this author
Iijima, H. Browse this author
Aiyama, T. Browse this author
Taketomi, A. Browse this author →KAKEN DB
Issue Date: Jun-2020
Publisher: John Wiley & Sons
Journal Title: BJS Open
Volume: 4
Issue: 3
Start Page: 486
End Page: 498
Publisher DOI: 10.1002/bjs5.50263
Abstract: Background The Endoscopic Surgical Skill Qualification System (ESSQS) was introduced in Japan to improve the quality of laparoscopic surgery. This cohort study investigated the short- and long-term postoperative outcomes of colorectal cancer laparoscopic procedures performed by or with qualified surgeons compared with outcomes for unqualified surgeons. Methods All laparoscopic colorectal resections performed from 2010 to 2013 in 11 Japanese hospitals were reviewed retrospectively. The procedures were categorized as performed by surgeons with or without the ESSQS qualification and patients' clinical, pathological and surgical features were used to match subgroups using propensity scoring. Outcome measures included postoperative and long-term results. Results Overall, 1428 procedures were analysed; 586 procedures were performed with ESSQS-qualified surgeons and 842 were done by ESSQS-unqualified surgeons. Upon matching, two cohorts of 426 patients were selected for comparison of short-term results. A prevalence of rectal resection (50.3 versus 40.5 per cent; P < 0.001) and shorter duration of surgery (230 versus 238 min; P = 0.045) was reported for the ESSQS group. Intraoperative and postoperative complication and reoperation rates were significantly lower in the ESSQS group than in the non-ESSQS group (1.2 versus 3.6 per cent, P = 0.014; 4.6 versus 7.5 per cent, P = 0.025; 1.9 versus 3.9 per cent, P = 0.023, respectively). These findings were confirmed after propensity score matching. Cox regression analysis found that non-attendance of ESSQS-qualified surgeons (hazard ratio 12.30, 95 per cent c.i. 1.28 to 119.10; P = 0.038) was independently associated with local recurrence in patients with stage II disease. Conclusion Laparoscopic colorectal procedures performed with ESSQS-qualified surgeons showed improved postoperative results. Further studies are needed to investigate the impact of the qualification on long-term oncological outcomes.
Type: article
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

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