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

Year 2022, Volume: 47 Issue: 3, 1359 - 1365, 30.09.2022

Mehmet Ali Koç

https://doi.org/10.17826/cumj.1162953

Abstract

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.

Keywords

complete mesocolic excision, laparoscopy, CUSUM, Learning curve

Thanks

I would like to thank Atilla H. Elhan, PhD for his help in statistical analysis. I also would like to thank Cihangir Akyol, MD, FASCRS, FEBS(Coloproctology) for his permission to analyse his cases.

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

Abstract

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.

Keywords

komplet mezokolik eksizyon, laparoskopi, CUSUM, öğrenme eğrisi

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