Evidence map›Paper›PMID 39028345›Full record

ArticleSurgical endoscopy2024

Learning curve and safety of the implementation of laparoscopic complete mesocolic excision with intracorporeal anastomosis for right-sided colon cancer: results from a propensity score-matched study.

Javier Vela, Christophe Riquoir, Cristián Jarry, Felipe Silva, Nicolás Besser, Gonzalo Urrejola, María Elena Molina, Rodrigo Miguieles, Felipe Bellolio, José Tomás Larach

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In one paragraph

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 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Javier VelaColorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 4th Floor, Santiago, Chile.
Christophe RiquoirColorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 4th Floor, Santiago, Chile.
Cristián JarryColorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 4th Floor, Santiago, Chile.
Felipe SilvaColorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 4th Floor, Santiago, Chile.
Nicolás BesserColorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 4th Floor, Santiago, Chile.
Gonzalo UrrejolaColorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 4th Floor, Santiago, Chile.
María Elena MolinaColorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 4th Floor, Santiago, Chile.
Rodrigo MiguielesColorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 4th Floor, Santiago, Chile.
Felipe BellolioColorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 4th Floor, Santiago, Chile.
José Tomás LarachColorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 4th Floor, Santiago, Chile. jtlarach@uc.cl.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRetrospective studies and randomized controlled trials support the safety of laparoscopic complete mesocolic excision (CME) for the treatment of right-sided colon cancer (RSCC). Few studies, however, examine the learning curve of this operation and its impact on safety during an implementation period. We aim to evaluate the learning curve and safety of the implementation of laparoscopic CME with intracorporeal anastomosis for RSCC.

methodsConsecutive patients undergoing a laparoscopic right colectomy with intracorporeal anastomosis for RSCC between January 2016 and June 2023 were included. Clinical, perioperative, and histopathological variables were collected. Correlation and cumulative sum (CUSUM) analyses between the operating time and case number were performed. Breakpoints of the learning curve were estimated using the broken-line model. CME and conventional laparoscopic right colectomy outcomes were compared after propensity score matching (PSM).

resultsTwo hundred and ninety patients underwent laparoscopic right colectomy during study period. One hundred and eight met inclusion criteria. After PSM, 56 non-CME and 28 CME patients were compared. CME group had a non-statistically significant tendency to a longer operating time (201 versus 195 min; p = 0.657) and a shorter hospital stay (3 versus 4 days; p = 0.279). No significant differences were found in total complication rates or their profile. Correlation analysis identified a significant trend toward operating time reduction with increasing case numbers (Pearson correlation coefficient =  - 0.624; p = 0.001). According to the CUSUM analysis, an institutional learning curve was deemed completed after 13 cases and the broken-line model identified three phases: learning (1-6 cases), consolidation (7-13 cases), and mastery (after 13 cases).

conclusionThe learning curve of laparoscopic CME for RSCC can be achieved after 13 cases in centers with experience in advanced laparoscopic surgery and surgeons with familiarity with this technique. Its implementation within this setting seems to be as safe as performing a conventional right colectomy.

Indexed as

Anastomosis, SurgicalColectomyColonic NeoplasmsLaparoscopyLearning CurveMesocolonOperative TimePropensity ScoreAgedFemaleHumansLength of StayMaleMiddle AgedPostoperative ComplicationsRetrospective StudiesColon cancerComplete mesocolic excisionImplementationLaparoscopic colectomyLearning curveRight hemicolectomy

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.