Laparoscopic Colorectal Surgery Outcomes Improved After National Training Program (LAPCO) for Specialists in England

Area of Science:

• Colorectal Surgery
• Surgical Training
• Minimally Invasive Surgery

Background:

• The National Training Program for Lapco (Lapco) provided competency-based training for specialist colorectal surgeons in England.
• Evaluating the impact of structured surgical training programs on clinical outcomes is crucial for improving patient care.

Purpose of the Study:

• To assess the effect of the Lapco training program on the adoption of laparoscopic surgery.
• To evaluate the impact of Lapco training on clinical outcomes, including mortality and morbidity, for colorectal cancer resections.

Main Methods:

• A difference-in-differences analysis compared laparoscopic surgery rates, mortality, and morbidity for Lapco delegates versus non-Lapco surgeons.
• Pre- and post-training periods were analyzed over three years.
• Risk-adjusted cumulative sum analysis assessed the predictive validity of in-training competency and global assessment scores.

Main Results:

• Lapco delegates showed a significant increase in laparoscopic colorectal cancer resections (37.8%) compared to non-Lapco surgeons.
• A relative decrease in 30-day and 90-day mortality was observed in the Lapco group.
• Competency assessment scores (3.12) and global assessment scores (4.74) predicted clinical performance, correlating with increased laparoscopic rates.

Conclusions:

• The Lapco program effectively enhanced the rate of laparoscopic colorectal cancer surgery in England.
• The training initiative led to a reduction in patient mortality and morbidity.
• In-training assessment tools demonstrated predictive value for post-training clinical performance.