1. Learning Curves of Ivor Lewis Totally Minimally Invasive Esophagectomy by Hospital and Surgeon Characteristics: A Retrospective Multinational Cohort Study
- Author
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Magnus Nilsson, Gerjon Hannink, Ewout A. Kouwenhoven, Bastiaan R. Klarenbeek, Grard A. P. Nieuwenhuijzen, Camiel Rosman, Alan Patrick Ainsworth, Ioannis Rouvelas, Suzanne S. Gisbertz, Mark I. van Berge Henegouwen, Freek Daams, Frans van Workum, Meindert N. Sosef, Fatih Polat, Edwin S. van der Zaag, Edward Cheong, Michael Hareskov Larsen, Jean-Pierre E. N. Pierie, Juha Kauppi, Misha D. P. Luyer, Ingrid S. Martijnse, Marc J. van Det, Frits J. H. van den Wildenberg, Joos Heisterkamp, Robert E G J M Pierik, Donald L. van der Peet, Christian A. Gutschow, Jari Räsänen, Linda Claassen, Eelco B Wassenaar, Peter van Duijvendijk, Barbara S. Langenhoff, Ernst Jan van Nieuwenhoven, Surgery, CCA - Cancer Treatment and Quality of Life, and Amsterdam Gastroenterology Endocrinology Metabolism
- Subjects
Postoperative Complications/epidemiology ,medicine.medical_specialty ,Minimally Invasive Surgical Procedures/methods ,Esophageal Neoplasms ,education ,MEDLINE ,Laparoscopy/methods ,Cohort Studies ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,All institutes and research themes of the Radboud University Medical Center ,Postoperative Complications ,Invasive esophagectomy ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,Ivor lewis ,efficient learning ,Ivor Lewis totally minimally invasive esophagectomy ,Retrospective Studies ,Surgeons ,Esophageal Neoplasms/complications ,business.industry ,General surgery ,Esophagectomy/methods ,Hospitals ,Outcome parameter ,Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10] ,Esophagectomy ,Treatment Outcome ,Multi national ,Learning curve ,Anastomotic leakage ,learning curves ,Laparoscopy ,Surgery ,business ,Learning Curve ,Cohort study - Abstract
OBJECTIVE: To describe the pooled learning curves of Ivor Lewis totally minimally invasive esophagectomy (TMIE) in hospitals stratified by predefined hospital- and surgeon-related factors.BACKGROUND: Ivor Lewis (TMIE is known to have a long learning curve which is associated with considerable learning associated morbidity. It is unknown whether hospital and surgeon characteristics are associated with more efficient learning.METHODS: A retrospective analysis of prospectively collected data of consecutive Ivor Lewis TMIE patients in 14 European hospitals was performed. Outcome parameters used as proxy for efficient learning were learning curve length, learning associated morbidity, and the plateau level regarding anastomotic leakage and textbook outcome. Pooled incidences were plotted for the factor-based subgroups using generalized additive models and 2-phase models. Casemix predicted outcomes were plotted and compared with observed outcomes. The investigated factors included annual volume, TMIE experience, clinic visits, courses and fellowships followed, and proctor supervision.RESULTS: This study included 2121 patients. The length of the learning curve was shorter for centers with an annual volume >50 compared to centers with an annual volume CONCLUSIONS: More efficient learning was observed in centers with higher annual volume. Visiting an expert clinic, completing a fellowship, or implementation under a proctor's supervision were not associated with more efficient learning.
- Published
- 2022