ArticleSurgical endoscopy2024
Impact of the endoscopic surgical skill qualification system on conversion to laparotomy after low anterior resection for rectal cancer in Japan (a secondary analysis of the EnSSURE study).
Article in Surgical endoscopy, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 7 citations in OpenAlex.
- Intraoperative real-time recognition of dissectible layers by artificial intelligence is useful in laparoscopic inguinal hernia repair.Surgical endoscopy · 2026Article
- Interaction Between Operator and Assistant Certification Is Associated With Local Recurrence After Laparoscopic Rectal Cancer Surgery: An Ancillary Analysis of the EnSSURE Study.Annals of gastroenterological surgery · 2026Article
- Effect of the endoscopic surgical skill qualification system for laparoscopic right colectomy: a Japanese multicenter analysis.Surgery today · 2026Article
- Artificial intelligence-enhanced navigation for nerve recognition and surgical education in laparoscopic colorectal surgery.Surgical endoscopy · 2025Article
- Effect of endoscopic surgical skill qualification system for laparoscopic rectal surgery: Japanese multicenter analysis.Surgical endoscopy · 2025Article
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Authors and funding
13 authors at 9 institutions in 1 country.
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Abstract
BACKGROUND AND
aimsConversion to laparotomy is among the serious intraoperative complications and carries an increased risk of postoperative complications. In this cohort study, we investigated whether or not the Endoscopic Surgical Skill Qualification System (ESSQS) affects the conversion rate among patients undergoing laparoscopic surgery for rectal cancer.
methodsWe performed a retrospective secondary analysis of data collected from patients undergoing laparoscopic surgery for cStage II and III rectal cancer from 2014 to 2016 across 56 institutions affiliated with the Japan Society of Laparoscopic Colorectal Surgery. Data from the original EnSSURE study were analyzed to investigate risk factors for conversion to laparotomy by performing univariate and multivariate analyses based on the reason for conversion.
resultsData were collected for 3,168 cases, including 65 (2.1%) involving conversion to laparotomy. Indicated conversion accounted for 27 cases (0.9%), while technical conversion accounted for 35 cases (1.1%). The multivariate analysis identified the following independent risk factors for indicated conversion to laparotomy: tumor diameter [mm] (odds ratio [OR] 1.01, 95% confidence interval [CI] 1.01-1.05, p = 0.0002), combined resection of adjacent organs [+/-] (OR 7.92, 95% CI 3.14-19.97, p < 0.0001), and surgical participation of an ESSQS-certified physician [-/+] (OR 4.46, 95% CI 2.01-9.90, p = 0.0002). The multivariate analysis identified the following risk factors for technical conversion to laparotomy: registered case number of institution (OR 0.99, 95% CI 0.99-1.00, p = 0.0029), institution type [non-university/university hospital] (OR 3.52, 95% CI 1.54-8.04, p = 0.0028), combined resection of adjacent organs [+/-] (OR 5.96, 95% CI 2.15-16.53, p = 0.0006), and surgical participation of an ESSQS-certified physician [-/+] (OR 6.26, 95% CI 3.01-13.05, p < 0.0001).
conclusionsParticipation of ESSQS-certified physicians may reduce the risk of both indicated and technical conversion. Referral to specialized institutions, such as high-volume centers and university hospitals, especially for patients exhibiting relevant background risk factors, may reduce the risk of conversion to laparotomy and lead to better outcomes for patients.
trial registrationThis study was registered with the Japanese Clinical Trials Registry as UMIN000040645.
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