Does a Successful Total Mesorectal ExcisionRequire a Learning Curve?.
- Author:
Seung Yeop OH
1
;
Do Yun KIM
;
Jong Min PARK
;
Seung Hyun PARK
;
Kwang Wook SUH
Author Information
1. Department of Surgery, Ajou University School of Medicine, Suwon, Korea. suhkw@ajou.ac.kr
- Publication Type:Original Article ; Clinical Trial
- Keywords:
Rectal cancer;
Total mesorectal excision;
Learning curve
- MeSH:
Bias (Epidemiology);
Humans;
Learning;
Learning Curve;
Rectal Neoplasms;
Recurrence;
Retrospective Studies
- From:Journal of the Korean Surgical Society
2008;74(3):207-211
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: This study was conducted to determine whether a learning curve is necessary to obtain a successful total mesorectal excision (TME) for mid or low rectal cancer. METHODS: We retrospectively reviewed the records of 80 patients that underwent a total mesorectal excision for mid or low rectal cancer between 1994 and 1998 and between 1999 and 2002. We compared the results between the two period groups. Endpoints were postoperative urological functions and the local recurrence rate. RESULTS: There was no significant difference for age, gender, tumor differentiation and stage between patients in the two groups. Local recurrence (LR) developed in 23% of patients in the early group and 7.5% of patients in the late group. The cumulative LR risk at 60 months was 27.5% for the early period group and 9.9% for the late period group (P=0.082) and the difference between the two groups was significant for TNM III stage (29.8% vs. 9.8%, P=0.049). Postoperative urological complications were not significantly different between the two groups (P=0.75). CONCLUSION: Based on these results, TME seemed to require a learning curve. In clinical trials for rectal cancer surgery, the learning curve for qualified surgery from the standpoint of oncological outcome should be considered to minimize bias due to surgeon-associated factors. A more broad application of the TME concept to a larger number of patients with mid or low rectal cancer is warranted.
