Evaluation of the advantage of surgeons certified by the endoscopic surgical skill qualification system participating in laparoscopic low anterior rectal resection

• Published in: Annals of gastroenterological surgery 2024-05, Vol.8 (3), p.464-470
• Main Authors: Sawada, Naruhiko, Akagi, Tomonori, Shimomura, Manabu, Todate, Yukitoshi, Nagakari, Kunihiko, Takeshita, Hiroaki, Maruyama, Satoshi, Takata, Manabu, Iijima, Hiroaki, Yamaguchi, Shigeki, Taketomi, Akinobu, Naitoh, Takeshi, Furutani, Akinobu, Kanazawa, Akiyoshi, Noda, Akiyoshi, Ishibe, Atsushi, Tani, Chikayoshi, Yamamoto, Daisuke, Fujita, Fumihiko, Teraishi, Fuminori, Ishida, Fumio, Asahara, Fumitaka, Ozawa, Heita, Karasawa, Hideaki, Osawa, Hideki, Ota, Hirofumi, Suwa, Hirokazu, Ochiai, Hiroki, Ogawa, Hiroomi, Saeki, Hiroshi, Bando, Hiroyuki, Horie, Hisanaga, Nagahara, Hisashi, Watanabe, Jun, Hayashibara, Kaori, Takehara, Kazuhiro, Kojo, Ken, Okamoto, Ken, Saito, Kenichiro, Ikeda, Koji, Munakata, Koji, Otsuka, Koki, Uemura, Mamoru, Yamamoto, Manabu, Ito, Masaaki, Numata, Masakatsu, Watanabe, Masahiko, Miguchi, Masashi, Shibutani, Masatsune, Ozawa, Mayumi, Takatsuki, Mitsuhisa, Aisu, Naoya, Suzuki, Nobuaki, Ikeshima, Ryo, Inada, Ryo, Oshima, Ryuichi, Kojima, Shigehiro, Homma, Shigenori, Fujino, Shiki, Mori, Shinichiro, Ohnuma, Shinobu, Takeda, Sho, Aoyama, Shota, Saito, Shuji, Takahashi, Shusaku, Sasaki, Takahiro, Yamanashi, Takahiro, Matsuda, Takeru, Miura, Takuya, Fukuoka, Tatsunari, Ono, Tatsunori, Shonaka, Tatsuya, Godai, Teni, Funakoshi, Tohru, Adachi, Tomohiro, Yamaguchi, Tomohiro, Furuhata, Tomohisa, Kimura, Toshimoto, Aiba, Toshisada, Nagasaki, Toshiya, Fujiwara, Toshiyoshi, Shimamura, Tsukasa, Mizushima, Tsunekazu, Iseki, Yasuhito, Sumi, Yasuo, Kamada, Yasuyuki, Kurose, Yohei, Kita, Yoshiaki, Kakeji, Yoshihiro, Takashima, Yoshihiro, Ide, Yoshihito, Sakai, Yoshiharu, Munemoto, Yoshinori, Akagi, Yoshito, Ishii, Yoshiyuki, Kiyozumi, Yuki, Kokuba, Yukihito, Suwa, Yusuke, Sakimura, Yusuke, Shimodaira, Yusuke
• Format: Article
• Language: English
• Subjects: Body mass index; Colorectal cancer; Dissection; endoscopic surgical skill qualification system; Endoscopy; laparoscopic low anterior resection; Laparoscopy; Lymphatic system; Medical personnel; Ostomy; Participation; Patients; rectal cancer; Statistical analysis; Surgeons; Surgery; Surgical anastomosis; Surgical outcomes; Survival analysis
• ISSN: 2475-0328; 2475-0328
• DOI: 10.1002/ags3.12763

Background A technical qualification system was developed in 2004 by the Japan Society for Endoscopic Surgery. An analysis of the EnSSURE study on 3188 stage II–III rectal cancer patients, which was performed by including the participation of qualified surgeons as assistants and advisers without restricting their participation as operators, revealed that the participation of technically qualified surgeons in surgery improved the technical and oncological safety of laparoscopic rectal resection. Aim This secondary retrospective analysis of the EnSSURE study examined the advantage of qualified surgeons participating in laparoscopic low anterior resection (LAR). Methods The outcomes of low anterior resection were compared between groups with and without the participation of surgeons qualified by the Endoscopic Surgical Skill Qualification System (Q and non‐Q groups, respectively). We used propensity score matching to generate paired cohorts at a one‐to‐one ratio. The postoperative complication rate, short‐term results (hemorrhage volume, operative time, number of dissected lymph nodes, open conversion rate, intraoperative complication rate, and R0 resection rate), and long‐term results (disease‐free survival rate, local recurrence rate, and overall survival rate) were evaluated. Results The frequencies of postoperative complications, anastomotic bleeding, and intraperitoneal abscess were significantly lower, the operative time was significantly shorter, the postoperative hospital stay was significantly shorter, and the number of dissected lymph nodes was higher in the Q group. No significant differences were observed in disease‐free survival, local recurrence, or overall survival rate rates between the groups. Conclusion The participation of qualified surgeons in LAR is technically advantageous. A technical qualification system was developed in 2004 by the Japan Society for Endoscopic Surgery, and an analysis of the EnSSURE study revealed that the participation of technically qualified surgeons in surgery improved the technical and oncological safety of laparoscopic rectal resection. Our secondary retrospective analysis of the EnSSURE study examined the advantages of qualified surgeons participating in laparoscopic low anterior resection. The participation of qualified surgeons in LAR was shown to be technically advantageous.