ArticleSurgical endoscopy2025
Structured surgical training in minimally invasive esophagectomy (MIE) increases textbook outcome-a risk-adjusted learning curve.
Article in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Learning curve-associated safety in minimally invasive esophagectomy using a time-based supervisory takeover strategy: a propensity score-weighted analysis of 603 VATS procedures.Surgical endoscopy · 2026Article
- Article
- Cervical Anastomotic Leakage After Minimally Invasive McKeown Esophagectomy in the SAFER Surgical System: Clinical Course and Predictors of Delayed Healing.Thoracic cancer · 2026Article
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13 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundMinimally Invasive Esophagectomy (MIE) is a complex surgical procedure that has become a cornerstone in the management of esophageal cancer. This study aims to delineate the learning curve associated with MIE and its impact on patient outcomes.
methodsA retrospective analysis was conducted on 191 patients who underwent MIE between 2015 and 2022. The cohort was divided into two groups according to the level of competence: Trainer (n = 100) and Trainee (n = 91). Patient demographics, tumor characteristics, and surgical parameters were examined. RA-CUSUM methodology was employed to monitor patient outcomes, adjusting for variations in risk profiles using varying-coefficient logistic regression models to establish the MIE proficiency learning curve.
resultsThe trainee achieved competence in terms of operative time within 47 cases, following risk adjustment. Similarly, the learning curve in terms of major complications was completed after the 55th consecutive case. The LC was completed in terms of increased incidence of TO achievement in the trainee group after 83 cases (Trainer vs. Trainee, 27.00% vs. 40.66%, p = 0.046). Anastomotic leakage (Trainer vs. Trainee, 10.00% vs. 7.69% (p = 0.575)) could be identified with consistent rates for both trainer and trainee during the observational period. Pulmonary complications accounted for the majority of complications. After a follow-up of 2 years, no effect of the learning curve on overall (p = 0.436) or disease-free (p = 0.305) survival could be concluded, indicating consistent quality and patient safety during the surgical training.
conclusionsWhile technical competence can be achieved after approximately 55 cases, achievement of 'textbook outcome' (TO) requires 83 cases. The findings demonstrate that structured surgical training can progress in tandem while maintaining oncological safety for patients. While technical competence is crucial, the ultimate goal should be achieving a TO.
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