Learning curve and safety of the implementation of laparoscopic complete mesocolic excision with intracorporeal anastomosis for right-sided colon cancer: results from a propensity score-matched study

• Published in: Surgical endoscopy Vol. 38; no. 9; pp. 5114 - 5121
• Main Authors: Vela, Javier, Riquoir, Christophe, Jarry, Cristián, Silva, Felipe, Besser, Nicolás, Urrejola, Gonzalo, Molina, María Elena, Miguieles, Rodrigo, Bellolio, Felipe, Larach, José Tomás
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-09-2024; Springer Nature B.V
• Subjects: Abdominal Surgery; Aged; Anastomosis, Surgical - education; Anastomosis, Surgical - methods; Colectomy - education; Colectomy - methods; Colonic Neoplasms - pathology; Colonic Neoplasms - surgery; Colorectal cancer; Female; Gastroenterology; Gynecology; Hepatology; Humans; Laparoscopy; Laparoscopy - education; Laparoscopy - methods; Learning Curve; Learning curves; Length of Stay - statistics & numerical data; Male; Medicine; Medicine & Public Health; Mesocolon - surgery; Middle Aged; Operative Time; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Proctology; Propensity Score; Retrospective Studies; Surgery; Laparoscopic colectomy; Colon cancer; Learning curve; Complete mesocolic excision; Right hemicolectomy; Implementation
• ISSN: 0930-2794; 1432-2218; 1432-2218
• DOI: 10.1007/s00464-024-11086-1

Background
Retrospective studies and randomized controlled trials support the safety of laparoscopic complete mesocolic excision (CME) for the treatment of right-sided colon cancer (RSCC). Few studies, however, examine the learning curve of this operation and its impact on safety during an implementation period. We aim to evaluate the learning curve and safety of the implementation of laparoscopic CME with intracorporeal anastomosis for RSCC.
Methods
Consecutive patients undergoing a laparoscopic right colectomy with intracorporeal anastomosis for RSCC between January 2016 and June 2023 were included. Clinical, perioperative, and histopathological variables were collected. Correlation and cumulative sum (CUSUM) analyses between the operating time and case number were performed. Breakpoints of the learning curve were estimated using the broken-line model. CME and conventional laparoscopic right colectomy outcomes were compared after propensity score matching (PSM).
Results
Two hundred and ninety patients underwent laparoscopic right colectomy during study period. One hundred and eight met inclusion criteria. After PSM, 56 non-CME and 28 CME patients were compared. CME group had a non-statistically significant tendency to a longer operating time (201 versus 195 min;
p
 = 0.657) and a shorter hospital stay (3 versus 4 days;
p
 = 0.279). No significant differences were found in total complication rates or their profile. Correlation analysis identified a significant trend toward operating time reduction with increasing case numbers (Pearson correlation coefficient =  − 0.624;
p
 = 0.001). According to the CUSUM analysis, an institutional learning curve was deemed completed after 13 cases and the broken-line model identified three phases: learning (1–6 cases), consolidation (7–13 cases), and mastery (after 13 cases).
Conclusion
The learning curve of laparoscopic CME for RSCC can be achieved after 13 cases in centers with experience in advanced laparoscopic surgery and surgeons with familiarity with this technique. Its implementation within this setting seems to be as safe as performing a conventional right colectomy.