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Evaluation of the learning curve for conformal sphincter preservation operation in the treatment of ultralow rectal cancer

BACKGROUND: To investigate the learning curve of conformal sphincter preservation operation (CSPO) in the treatment of ultralow rectal cancer and to further explore the influencing factors of operation time. METHODS: From August 2011 to April 2020, 108 consecutive patients with ultralow rectal cance...

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Autores principales: Ding, Hai-bo, Wang, Lin-hui, Sun, Ge, Yu, Guan-yu, Gao, Xian-hua, Zheng, Kuo, Gong, Hai-feng, Sui, Jin-ke, Zhu, Xiao-ming, Zhang, Wei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8966240/
https://www.ncbi.nlm.nih.gov/pubmed/35354489
http://dx.doi.org/10.1186/s12957-022-02541-1
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author Ding, Hai-bo
Wang, Lin-hui
Sun, Ge
Yu, Guan-yu
Gao, Xian-hua
Zheng, Kuo
Gong, Hai-feng
Sui, Jin-ke
Zhu, Xiao-ming
Zhang, Wei
author_facet Ding, Hai-bo
Wang, Lin-hui
Sun, Ge
Yu, Guan-yu
Gao, Xian-hua
Zheng, Kuo
Gong, Hai-feng
Sui, Jin-ke
Zhu, Xiao-ming
Zhang, Wei
author_sort Ding, Hai-bo
collection PubMed
description BACKGROUND: To investigate the learning curve of conformal sphincter preservation operation (CSPO) in the treatment of ultralow rectal cancer and to further explore the influencing factors of operation time. METHODS: From August 2011 to April 2020, 108 consecutive patients with ultralow rectal cancer underwent CSPO by the same surgeon in the Department of Colorectal Surgery of Changhai Hospital. The moving average and cumulative sum control chart (CUSUM) curve were used to analyze the learning curve. The preoperative clinical baseline data, postoperative pathological data, postoperative complications, and survival data were compared before and after the completion of learning curve. The influencing factors of CSPO operation time were analyzed by univariate and multivariate analysis. RESULTS: According to the results of moving average and CUSUM method, CSPO learning curve was divided into learning period (1–45 cases) and learning completion period (46–108 cases). There was no significant difference in preoperative clinical baseline data, postoperative pathological data, postoperative complications, and survival data between the two stages. Compared with the learning period, the operation time (P < 0.05), blood loss (P < 0.05), postoperative flatus and defecation time (P < 0.05), liquid diet time (P < 0.05), and postoperative hospital stay (P < 0.05) in the learning completion period were significantly reduced, and the difference was statistically significant. Univariate and multivariate analysis showed that distance of tumor from anal verge (≥ 4cm vs. < 4cm, P = 0.039) and T stage (T3 vs. T1-2, P = 0.022) was independent risk factors for prolonging the operation time of CSPO. CONCLUSIONS: For surgeons with laparoscopic surgery experience, about 45 cases of CSPO are needed to cross the learning curve. At the initial stage of CSPO, beginners are recommended to select patients with ultralow rectal cancer whose distance of tumor from anal verge is less than 4 cm and tumor stage is less than T3 for practice, which can enable beginners to reduce the operation time, accumulate experience, build self-confidence, and shorten the learning curve on the premise of safety.
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spelling pubmed-89662402022-03-31 Evaluation of the learning curve for conformal sphincter preservation operation in the treatment of ultralow rectal cancer Ding, Hai-bo Wang, Lin-hui Sun, Ge Yu, Guan-yu Gao, Xian-hua Zheng, Kuo Gong, Hai-feng Sui, Jin-ke Zhu, Xiao-ming Zhang, Wei World J Surg Oncol Research BACKGROUND: To investigate the learning curve of conformal sphincter preservation operation (CSPO) in the treatment of ultralow rectal cancer and to further explore the influencing factors of operation time. METHODS: From August 2011 to April 2020, 108 consecutive patients with ultralow rectal cancer underwent CSPO by the same surgeon in the Department of Colorectal Surgery of Changhai Hospital. The moving average and cumulative sum control chart (CUSUM) curve were used to analyze the learning curve. The preoperative clinical baseline data, postoperative pathological data, postoperative complications, and survival data were compared before and after the completion of learning curve. The influencing factors of CSPO operation time were analyzed by univariate and multivariate analysis. RESULTS: According to the results of moving average and CUSUM method, CSPO learning curve was divided into learning period (1–45 cases) and learning completion period (46–108 cases). There was no significant difference in preoperative clinical baseline data, postoperative pathological data, postoperative complications, and survival data between the two stages. Compared with the learning period, the operation time (P < 0.05), blood loss (P < 0.05), postoperative flatus and defecation time (P < 0.05), liquid diet time (P < 0.05), and postoperative hospital stay (P < 0.05) in the learning completion period were significantly reduced, and the difference was statistically significant. Univariate and multivariate analysis showed that distance of tumor from anal verge (≥ 4cm vs. < 4cm, P = 0.039) and T stage (T3 vs. T1-2, P = 0.022) was independent risk factors for prolonging the operation time of CSPO. CONCLUSIONS: For surgeons with laparoscopic surgery experience, about 45 cases of CSPO are needed to cross the learning curve. At the initial stage of CSPO, beginners are recommended to select patients with ultralow rectal cancer whose distance of tumor from anal verge is less than 4 cm and tumor stage is less than T3 for practice, which can enable beginners to reduce the operation time, accumulate experience, build self-confidence, and shorten the learning curve on the premise of safety. BioMed Central 2022-03-30 /pmc/articles/PMC8966240/ /pubmed/35354489 http://dx.doi.org/10.1186/s12957-022-02541-1 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Ding, Hai-bo
Wang, Lin-hui
Sun, Ge
Yu, Guan-yu
Gao, Xian-hua
Zheng, Kuo
Gong, Hai-feng
Sui, Jin-ke
Zhu, Xiao-ming
Zhang, Wei
Evaluation of the learning curve for conformal sphincter preservation operation in the treatment of ultralow rectal cancer
title Evaluation of the learning curve for conformal sphincter preservation operation in the treatment of ultralow rectal cancer
title_full Evaluation of the learning curve for conformal sphincter preservation operation in the treatment of ultralow rectal cancer
title_fullStr Evaluation of the learning curve for conformal sphincter preservation operation in the treatment of ultralow rectal cancer
title_full_unstemmed Evaluation of the learning curve for conformal sphincter preservation operation in the treatment of ultralow rectal cancer
title_short Evaluation of the learning curve for conformal sphincter preservation operation in the treatment of ultralow rectal cancer
title_sort evaluation of the learning curve for conformal sphincter preservation operation in the treatment of ultralow rectal cancer
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8966240/
https://www.ncbi.nlm.nih.gov/pubmed/35354489
http://dx.doi.org/10.1186/s12957-022-02541-1
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