Evaluation of the advantage of surgeons certified by the endoscopic surgical skill qualification system participating in laparoscopic low anterior rectal resection

Naruhiko Sawada; Tomonori Akagi; Manabu Shimomura; Yukitoshi Todate; Kunihiko Nagakari; Hiroaki Takeshita; Satoshi Maruyama; Manabu Takata; Nobuki Ichikawa; Koya Hida; Hiroaki Iijima; Shigeki Yamaguchi; Akinobu Taketomi; Takeshi Naitoh; EnSSURE Study Group Collaboratives in Japan Society of Laparoscopic Colorectal Surgery.

doi:10.1002/ags3.12763

Evaluation of the advantage of surgeons certified by the endoscopic surgical skill qualification system participating in laparoscopic low anterior rectal resection

Ann Gastroenterol Surg. 2023 Dec 14;8(3):464-470. doi: 10.1002/ags3.12763. eCollection 2024 May.

Authors

Collaborators

EnSSURE Study Group Collaboratives in Japan Society of Laparoscopic Colorectal Surgery.:
Akinobu Furutani, Akiyoshi Kanazawa, Akiyoshi Noda, Atsushi Ishibe, Chikayoshi Tani, Daisuke Yamamoto, Fumihiko Fujita, Fuminori Teraishi, Fumio Ishida, Fumitaka Asahara, Heita Ozawa, Hideaki Karasawa, Hideki Osawa, Hiroaki Nagano, Hirofumi Ota, Hirokazu Suwa, Hiroki Ochiai, Hiroomi Ogawa, Hiroshi Saeki, Hirotoshi Hasegawa, Hiroyuki Bando, Hisanaga Horie, Hisashi Nagahara, Jun Watanabe, Kaori Hayashibara, Kay Uehara, Kazuhiro Takehara, Ken Kojo, Ken Okamoto, Kenichiro Saito, Koji Ikeda, Koji Munakata, Koki Otsuka, Koki Goto, Mamoru Uemura, Manabu Shiozawa, Manabu Yamamoto, Masaaki Ito, Masafumi Inomata, Masakatsu Numata, Masahiko Watanabe, Masashi Miguchi, Masatsune Shibutani, Mayumi Ozawa, Mitsuhisa Takatsuki, Naoya Aisu, Nobuaki Suzuki, Ryo Ikeshima, Ryo Inada, Ryuichi Oshima, Shigehiro Kojima, Shigenori Homma, Shiki Fujino, Shinichiro Mori, Shinobu Ohnuma, Sho Takeda, Shota Aoyama, Shuji Saito, Shunpei Mukai, Shusaku Takahashi, Takahiro Sasaki, Takahiro Yamanashi, Takeru Matsuda, Takuya Miura, Tatsunari Fukuoka, Tatsunori Ono, Tatsuya Kinjo, Tatsuya Shonaka, Teni Godai, Tohru Funakoshi, Tomohiro Adachi, Tomohiro Yamaguchi, Tomohisa Furuhata, Toshimoto Kimura, Toshisada Aiba, Toshiya Nagasaki, Toshiyoshi Fujiwara, Tsukasa Shimamura, Tsunekazu Mizushima, Yasuhito Iseki, Yasuo Sumi, Yasushi Rino, Yasuyuki Kamada, Yohei Kurose, Yoshiaki Kita, Yoshihiro Kakeji, Yoshihiro Takashima, Yoshihito Ide, Yoshiharu Sakai, Yoshinori Munemoto, Yoshito Akagi, Yoshiyuki Ishii, Yuji Inoue, Yuki Kiyozumi, Yukihito Kokuba, Yusuke Suwa, Yusuke Sakimura, Yusuke Shimodaira

Affiliations

¹ Digestive Disease Center Showa University Northern Yokohama Hospital Yokohama Japan.
² Department of Gastroenterological and Pediatric Surgery Oita University Oita Japan.
³ Hiroshima City North Medical Center Asa Citizens Hospital Hiroshima Japan.
⁴ Department of Surgery Southern Tohoku General Hospital Koriyama Japan.
⁵ Department of Digestive and General Surgery Juntendo University Urayasu Hospital Urayasu Japan.
⁶ Department of Surgery National Hospital Organization Nagasaki Medical Center Nagasaki Japan.
⁷ Department of Gastroenterological Surgery Niigata Cancer Center Hospital Niigata Japan.
⁸ Department of Surgery Nagano Municipal Hospital Nagano Japan.
⁹ Department of Gastroenterological Surgery I, Graduate School of Medicine Hokkaido University Sapporo Japan.
¹⁰ Department of Surgery Kyoto University Hospital Kyoto Japan.
¹¹ Division of Colorectal Surgery, Department of Surgery Tokyo Women's Medical University Tokyo Japan.
¹² Department of Lower Gastrointestinal Surgery Kitasato University School of Medicine Sagamihara Japan.

Abstract

Background: A technical qualification system was developed in 2004 by the Japan Society for Endoscopic Surgery. An analysis of the EnSSURE study on 3188 stage II-III rectal cancer patients, which was performed by including the participation of qualified surgeons as assistants and advisers without restricting their participation as operators, revealed that the participation of technically qualified surgeons in surgery improved the technical and oncological safety of laparoscopic rectal resection.

Aim: This secondary retrospective analysis of the EnSSURE study examined the advantage of qualified surgeons participating in laparoscopic low anterior resection (LAR).

Methods: The outcomes of low anterior resection were compared between groups with and without the participation of surgeons qualified by the Endoscopic Surgical Skill Qualification System (Q and non-Q groups, respectively). We used propensity score matching to generate paired cohorts at a one-to-one ratio. The postoperative complication rate, short-term results (hemorrhage volume, operative time, number of dissected lymph nodes, open conversion rate, intraoperative complication rate, and R0 resection rate), and long-term results (disease-free survival rate, local recurrence rate, and overall survival rate) were evaluated.

Results: The frequencies of postoperative complications, anastomotic bleeding, and intraperitoneal abscess were significantly lower, the operative time was significantly shorter, the postoperative hospital stay was significantly shorter, and the number of dissected lymph nodes was higher in the Q group. No significant differences were observed in disease-free survival, local recurrence, or overall survival rate rates between the groups.

Conclusion: The participation of qualified surgeons in LAR is technically advantageous.

Keywords: endoscopic surgical skill qualification system; laparoscopic low anterior resection; rectal cancer.