Learning curve analysis for lateral pelvic lymph node dissection in rectal cancers - Outcomes improve with experience

Area of Science:

• Surgical Oncology
• Rectal Cancer Treatment
• Minimally Invasive Surgery

Background:

• Lateral pelvic lymph node dissection (LPLND) is a complex procedure for rectal cancer.
• The learning curve and factors influencing its success, particularly nodal yield, require detailed analysis.

Purpose of the Study:

• To determine the learning curve for LPLND in rectal cancer patients.
• To assess nodal retrieval as a key performance indicator for LPLND proficiency.

Main Methods:

• Retrospective analysis of consecutive LPLND procedures for rectal adenocarcinomas.
• Utilized cumulative sum (CUSUM) control charts to monitor lymph node yield.
• Negative binomial regression identified factors influencing nodal harvest.

Main Results:

• A median of 6 lymph nodes were retrieved, with 20% positivity.
• Increasing surgical experience and minimally invasive surgery (MIS) were significant factors for higher nodal yield.
• The learning curve plateaued after 83 cases overall and 19 MIS cases, with a 20% yield increase per 30 MIS LPLND.

Conclusions:

• The learning curve for LPLND is substantial.
• Surgical experience and the adoption of MIS are critical for optimizing nodal yield in LPLND for rectal cancer.