Interaction Between Operator and Assistant Certification Is Associated With Local Recurrence After Laparoscopic...

Area of Science:

• Surgical Oncology
• Colorectal Surgery
• Minimally Invasive Surgery

Background:

• Local recurrence (LR) is a significant concern following laparoscopic rectal cancer surgery.
• The influence of combined operator and assistant certification on LR risk is not well understood.
• Surgical expertise is crucial, but team dynamics may also play a role.

Purpose of the Study:

• To investigate the impact of operator and assistant certification on local recurrence after laparoscopic rectal cancer resection.
• To analyze the association between team qualifications and the 3-year cumulative incidence of local recurrence.

Main Methods:

• Retrospective analysis of 2825 patients with stage II-III rectal cancer undergoing laparoscopic resection (EnSSURE cohort).
• Primary endpoint: 3-year cumulative incidence of LR, with death and distant metastasis as competing events.
• Fine-Gray model used to assess the interaction between operator and assistant certification (Endoscopic Surgical Skill Qualification System).

Main Results:

• A significant interaction between operator and assistant certification was found, reducing LR risk (sHR 0.43, p=0.038).
• Individual qualifications alone were not independently associated with LR.
• The risk of LR was significantly higher when either the operator or assistant, or both, were not qualified (QN, NQ, NN groups vs. QQ group).

Conclusions:

• Combined operator and assistant certification is associated with a lower risk of local recurrence in laparoscopic rectal cancer surgery.
• Surgical outcomes appear to depend on the entire surgical team's composition and qualifications, not just individual expertise.
• This finding emphasizes the importance of team qualification in optimizing surgical results for rectal cancer patients.