Early Urinary Dysfunction after Laparoscopic Rectal Cancer Surgery: Does Surgeons' Learning Curve Matter?

Area of Science:

• Colorectal Surgery
• Urology
• Surgical Education

Background:

• Previous studies suggest poorer urinary outcomes in laparoscopic rectal cancer surgery compared to open procedures.
• The learning curve for surgeons may contribute to these observed differences in early postoperative urinary dysfunction.

Purpose of the Study:

• To investigate the influence of the learning curve in laparoscopic rectal cancer surgery on early postoperative urinary dysfunction.
• To identify risk factors associated with postoperative urinary retention (POUR) and major urinary dysfunction.

Main Methods:

• A prospective database of 208 patients undergoing laparoscopic rectal resection for cancer was analyzed.
• Surgeons' experience was categorized into learning curve (1-80 cases) and experienced (81-208 cases) periods.
• Multivariate analysis assessed the association between learning curve, age, and urinary outcomes (POUR, major urinary dysfunction).

Main Results:

• The overall incidence of POUR was 20.2%, and major urinary dysfunction was 4.3%.
• The learning curve for operative time stabilized around 80 cases.
• Older age and being in the learning curve period were independent risk factors for POUR (OR=2.241, P=0.024).
• The learning curve was not a significant risk factor for major urinary dysfunction (OR=3.378, P=0.092).

Conclusions:

• The learning curve is a significant risk factor for increased rates of postoperative urinary retention after laparoscopic rectal cancer surgery.
• Technical training is crucial to shorten the learning curve and minimize its impact on postoperative urinary complications.