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Learning curve analysis for prophylactic bilateral robot-assisted lateral lymph node dissection for lower rectal
T Sueda1, M Yasui2, J Nishimura2
1Department of Gastroenterological Surgery, Osaka International Cancer Institute, 69-1-3 Ootemae-Chuoku, Osaka, Osaka, 540-0008, Japan. sueda811@yahoo.co.jp.
Techniques in Coloproctology
|March 7, 2025
Summary
Robot-assisted lateral lymph node dissection (RA-LLND) for lower rectal cancer has a learning curve. Mastery of this technique is achieved after approximately 36 cases, with significant improvements in operative time and reduced complications.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Rectal Cancer Treatment
Background:
- Lateral lymph node dissection (LLND) is crucial for lower rectal cancer (RC).
- Limited data exist on the learning curve for robot-assisted LLND (RA-LLND).
- This study evaluates the learning curve for prophylactic bilateral RA-LLND in lower RC.
Purpose of the Study:
- To assess the learning curve for robot-assisted bilateral LLND in lower rectal cancer.
- To identify the number of cases required to achieve surgical proficiency.
- To analyze the impact of the learning curve on surgical outcomes and complications.
Main Methods:
- Retrospective analysis of 58 patients undergoing prophylactic bilateral RA-LLND for lower RC (July 2020 - June 2024).
- Cumulative sum (CUSUM) analysis applied to operative time to define learning curve phases.
- Comparison of surgical outcomes between early (phases 1-2) and late (phase 3) stages of the learning curve.
Main Results:
- CUSUM analysis identified three learning phases: initial (20 cases), competence (16 cases), and mastery (subsequent cases).
- Surgical mastery was achieved by the 36th case.
- Significant reductions observed in operative time (P < 0.01), blood loss (P < 0.01), and postoperative complications including urinary dysfunction (P = 0.02) in the mastery phase.
- Mean operative time decreased from 173.7 min in early phases to significantly less in the mastery phase.
Conclusions:
- The learning curve for prophylactic bilateral RA-LLND can be characterized by three distinct phases.
- Approximately 20 cases are needed for the initial learning phase.
- Surgical proficiency and improved outcomes are typically achieved after 36 cases of RA-LLND.
