Short- and mid-term outcomes after early surgical training in laparoscopic colorectal cancer surgery: trainees' performance has no negative impact.

ABSTRACT

BACKGROUND: This study aimed to evaluate the safety and quality of laparoscopic colorectal cancer surgery undertaken by trainees. PATIENTS AND METHODS: From a prospectively maintained database, we identified 456 consecutive patients who underwent laparoscopic resection for colorectal cancer between 2006 and 2010. Short-term operative outcomes, relapse-free survival (RFS), and overall survival (OS) were compared between operations undertaken by the experts (E group) and trainees (T group). Multivariate analyses were performed for RFS and OS in stage II/III disease. RESULTS: Trainees performed 313 surgeries (68.6%) and completed the procedure by themselves in 297 cases (94.9%). Short-term outcomes, including operative time, blood loss, conversion, complication, mortality, and retrieval of less than 12 lymph nodes, were comparable between the E group and the T group. After a median follow-up period of 35 months, RFS and OS were similar between the two groups, with the exception of OS for stage II (3-year OS for E group versus T group, 96.9% versus 87.0%; P=.029); however, this difference disappeared after multivariate analyses. Multivariate analyses showed that positive resection margin and higher log carcinoembryonic antigen (CEA) levels were associated with lower RFS. Furthermore, increasing age, positive resection margin, higher log CEA levels, intraoperative surgeon exchange, rectal cancer, postoperative complications, absence of postoperative chemotherapy, and shorter operative time were associated with poor OS. CONCLUSIONS: Laparoscopic operations undertaken by trainees did not negatively affect short-term outcomes and were not associated with impaired mid-term oncologic outcomes. Our findings support early initiation of training in laparoscopic surgery for colorectal cancer treatment.