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One surgeon’s learning curve for video-assisted thoracoscopic esophagectomy for esophageal cancer with the patient in lateral position: how many cases are needed to reach competence?

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Abstract

Background

Minimally invasive esophagectomy is a feasible technique shown to be safe and oncologically adequate for the treatment of esophageal cancer. This study aimed to describe one surgeon’s learning curve for video-assisted thoracoscopic esophagectomy with the patient in lateral position.

Methods

From May 2010 to June 2012, 89 thoracoscopic esophagectomies for esophageal cancer were performed by one surgeon. The patients were divided into three groups. Group A included the first 30 cases. Group B comprised cases 31 to 60, and group C included the final 29 cases. The demographic characteristics and the intra- and postoperative variables were collected retrospectively and analyzed.

Results

One postoperative death occurred. Eight patients required conversion. No significant difference in background or clinicopathologic factors among the three groups was observed. Compared with group A, a significant decrease in intrathoracic operative time (107.7 ± 16.2 min; P = 0.0000), total operative time (326.3 ± 40.7 min; P = 0.0002), and blood loss (290.8 ± 114.3 ml; P = 0.0129) was observed in group B, whereas more retrieved nodes were harvested (20.1 ± 9.5; P = 0.0002). The last 29 patients (group C) involved significantly less intrathoracic operative time (82.8 ± 18.4 min; P = 0.0386), total operative time (294.7 ± 37.4 min; P = 0.0009), and blood loss (234.7 ± 87.8 ml; P = 0.0125) as well as a shorter postoperative hospital stay (12.4 ± 3.7 days; P = 0.0125) compared with group B. A significant decline in the overall morbidity from group A to group C (P = 0.0005) also was observed.

Conclusions

The results of this study suggest that at least 30 cases were needed to reach the plateau of thoracoscopic esophagectomy. After more than 60 cases of thoracoscopic esophagectomies had been managed, lower morbidity could be obtained.

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References

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96

    Article  PubMed  Google Scholar 

  2. Enzinger PC, Mayer RJ (2003) Esophageal cancer. N Engl J Med 349:2241–2252

    Article  PubMed  CAS  Google Scholar 

  3. Smithers BM, Gotley DC, Martin I, Thomas JM (2007) Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg 245:232–240

    Article  PubMed  Google Scholar 

  4. Cuschieri A, Shimi S, Banting S (1992) Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb 37:7–11

    PubMed  CAS  Google Scholar 

  5. Law S, Fok M, Chu KM, Wong J (1997) Thoracoscopic esophagectomy for esophageal cancer. Surgery 122:8–14

    Article  PubMed  CAS  Google Scholar 

  6. Taguchi S, Osugi H, Higashino M, Tokuhara T, Takada N, Takemura M, Lee S, Kinoshita H (2003) Comparison of three-field esophagectomy for esophageal cancer incorporating open or thoracoscopic thoracotomy. Surg Endosc 17:1445–1450

    Article  PubMed  CAS  Google Scholar 

  7. Fukunaga T, Kidokoro A, Fukunaga M, Nagakari K, Suda M, Yoshikawa S (2001) Kinetics of cytokines and PMN-E in thoracoscopic esophagectomy. Surg Endosc 15:1484–1487

    PubMed  CAS  Google Scholar 

  8. Osugi H, Takemura M, Higashino M, Takada N, Lee S, Kinoshita H (2003) A comparison of video-assisted thoracoscopic oesophagectomy and radical lymph node dissection for squamous cell cancer of the oesophagus with open operation. Br J Surg 90:108–113

    Article  PubMed  CAS  Google Scholar 

  9. Miller JD, Jain MK, Gara CJ, Morgan D, Urschel JD (1997) Effect of surgical experience on results of esophagectomy for esophageal cancer. J Surg Oncol 65:20–21

    Article  PubMed  CAS  Google Scholar 

  10. Sutton DN, Wayman J, Griffin SM (1998) Learning curve for oesophageal cancer surgery. Br J Surg 85:1399–1402

    Article  PubMed  CAS  Google Scholar 

  11. Osugi H, Higashino M, Tokuhara T, Takada N, Takemura M, Katou H, Ueno M, Okuda E, Kinoshita H (2000) Technique of thoracoscopic dissection of mediastinal lymph node for esophageal cancer. In: Lomanto D, Kum CK, So JBT, Goh PMY (eds) Endoscopic surgery. Monduzze Editore, Bologna, pp 137–141

    Google Scholar 

  12. Osugi H, Takemura M, Higashino M, Takada N, Lee S, Ueno M, Tanaka Y, Fukuhara K, Hashimoto Y, Fujiwara Y, Kinoshita H (2002) Video-assisted thoracoscopic esophagectomy and radical lymph node dissection for esophageal cancer: a series of 75 cases. Surg Endosc 16:1588–1593

    Article  PubMed  CAS  Google Scholar 

  13. Rice TW, Blackstone EH, Rusch VW (2010) 7th edition of the AJCC Cancer Staging Manual: esophagus and esophagogastric junction. Ann Surg Oncol 17:1721–1724

    Article  PubMed  Google Scholar 

  14. Guo W, Zhao YP, Jiang YG, Niu HJ, Liu XH, Ma Z, Wang RW (2012) Prevention of postoperative chylothorax with thoracic duct ligation during video-assisted thoracoscopic esophagectomy for cancer. Surg Endosc 26:1332–1336

    Article  PubMed  Google Scholar 

  15. Deng B, Tan QY, Jiang YG, Zhao YP, Zhou JH, Chen GC, Wang RW (2010) Prevention of early delayed gastric emptying after high-level esophagogastrostomy by “pyloric digital fracture”. World J Surg 34:2837–2843

    Article  PubMed  Google Scholar 

  16. Puntambekar SP, Agarwal GA, Joshi SN, Rayate NV, Sathe RM, Patil AM (2010) Thoracolaparoscopy in the lateral position for esophageal cancer: the experience of a single institution with 112 consecutive patients. Surg Endosc 24:2407–2414

    Article  PubMed  Google Scholar 

  17. Wang H, Feng M, Tan L, Wang Q (2010) Comparison of the short-term quality of life in patients with esophageal cancer after subtotal esophagectomy via video-assisted thoracoscopic or open surgery. Dis Esophagus 23:408–414

    Article  PubMed  Google Scholar 

  18. Osugi H, Takemura M, Higashino M, Takada N, Lee S, Ueno M, Tanaka Y, Fukuhara K, Hashimoto Y, Fujiwara Y, Kinoshita H (2003) Learning curve of video-assisted thoracoscopic esophagectomy and extensive lymphadenectomy for squamous cell cancer of the thoracic esophagus and results. Surg Endosc 17:515–519

    Article  PubMed  CAS  Google Scholar 

  19. Luketich JD, Alvelo-Rivera M, Buenaventura PO, Christie NA, McCaughan JS, Litle VR, Schauer PR, Close JM, Fernando HC (2003) Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg 238:486–495

    PubMed  Google Scholar 

  20. Smithers BM, Gotley DC, McEwan D, Martin Bessell IJ, Doyle L (2001) Thoracoscopic mobilization of the esophagus: a 6-year experience. Surg Endosc 15:176–182

    Article  PubMed  CAS  Google Scholar 

  21. Dexter SPL, Martin IG, McMahonz MJ (1996) Radical thoracoscopic esophagectomy for cancer. Surg Endosc 10:147–151

    Article  PubMed  CAS  Google Scholar 

  22. Jarral OA, Purkayastha S, Athanasiou T, Zacharakis E (2011) Should thoracoscopic three-stage esophagectomy be performed in the prone or left lateral decubitus position? Interact Cardiovasc Thorac Surg 13:60–65

    Article  PubMed  Google Scholar 

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Disclosures

Wei Guo, Ying-Bo Zou, Zheng Ma, Hui-Jun Niu, Yao-Guang Jiang, Yun-Ping Zhao, Tai-Qian Gong, and Ru-Wen Wang have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Changjiang Route 10#, Daping, Chongqing, 400042, People’s Republic of China

    Wei Guo, Ying-Bo Zou, Zheng Ma, Hui-Jun Niu, Yao-Guang Jiang, Yun-Ping Zhao, Tai-Qian Gong & Ru-Wen Wang

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  1. Wei Guo
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  2. Ying-Bo Zou
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  3. Zheng Ma
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  4. Hui-Jun Niu
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  5. Yao-Guang Jiang
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  6. Yun-Ping Zhao
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  7. Tai-Qian Gong
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  8. Ru-Wen Wang
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Correspondence to Yao-Guang Jiang or Yun-Ping Zhao.

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Guo, W., Zou, YB., Ma, Z. et al. One surgeon’s learning curve for video-assisted thoracoscopic esophagectomy for esophageal cancer with the patient in lateral position: how many cases are needed to reach competence?. Surg Endosc 27, 1346–1352 (2013). https://doi.org/10.1007/s00464-012-2614-8

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  • DOI: https://doi.org/10.1007/s00464-012-2614-8

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