Learning curve analysis for lateral pelvic lymph node dissection in rectal cancers – Outcomes improve with experience

Lateral pelvic lymph node dissection (LPLND) is a technically challenging procedure and its learning curve has not been analysed against an oncologically relevant outcome. The purpose of the study was to determine the learning curve for LPLND in rectal cancers using nodal retrieval as performance me...

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Bibliographic Details
Published in:European journal of surgical oncology 2022-05, Vol.48 (5), p.1110-1116
Main Authors: Sukumar, Vivek, Kazi, Mufaddal, Gori, Jayesh, Ankathi, Suman Kumar, Baheti, Akshay, Ostwal, Vikas, Desouza, Ashwin, Saklani, Avanish
Format: Article
Language:English
Subjects:
Humans
Lateral pelvic lymph nodes
Learning Curve
Lymph Node Excision - methods
Lymph node yield
Lymph Nodes - pathology
Lymph Nodes - surgery
Neoadjuvant Therapy - adverse effects
Neoplasm Recurrence, Local - pathology
Rectal cancer
Rectal Neoplasms - pathology
Retrospective Studies
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Summary:Lateral pelvic lymph node dissection (LPLND) is a technically challenging procedure and its learning curve has not been analysed against an oncologically relevant outcome. The purpose of the study was to determine the learning curve for LPLND in rectal cancers using nodal retrieval as performance measure. Consecutive LPLND for rectal adenocarcinomas from a single institution were retrospectively analysed. Cumulative sum (CUSUM) control charts were used to detect difference in performance with respect to lymph node yield. Negative binomial regression was used to determine factors influencing nodal harvest using Incidence Risk Ratios (IRR). Separate CUSUM curves were generated for open and minimally invasive surgeries (MIS). One-hundred and twenty patients were included and all received preoperative radiation. MIS was used in 53.3%. Median lymph node yield was 6 with 20% nodal positivity. Increasing experience (IRR – 1.196) and MIS (IRR – 1.586) were the only factors that influenced nodal harvest. CUSUM charts revealed that learning curve was achieved after the 83rd case overall and after the 19 operations in MIS. There was a 20% increase in nodal yield after every 30 MIS LPLND performed. Learning curve for LPLND is relatively long and only increasing experience and minimally invasive operations increased nodal yield.
ISSN:0748-7983
1532-2157
DOI:10.1016/j.ejso.2021.12.003