Impact of Endoscopic Surgical Skill Qualification on Laparoscopic Resections for Rectal Cancer in Japan: The EnSSURE Study

Nobuki Ichikawa; Shigenori Homma; Koya Hida; Tomonori Akagi; Yasuyuki Kamada; Tomohiro Yamaguchi; Masaaki Ito; Fumio Ishida; Jun Watanabe; Daisuke Yamamoto; Hiroaki Iijima; Shigeki Yamaguchi; Masafumi Inomata; Yoshiharu Sakai; Takeshi Naitoh; Akinobu Taketomi

doi:10.1097/AS9.0000000000000160

Impact of Endoscopic Surgical Skill Qualification on Laparoscopic Resections for Rectal Cancer in Japan: The EnSSURE Study

Ann Surg Open. 2022 Apr 22;3(2):e160. doi: 10.1097/AS9.0000000000000160. eCollection 2022 Jun.

Authors

Nobuki Ichikawa¹, Shigenori Homma¹, Koya Hida², Tomonori Akagi³, Yasuyuki Kamada², Tomohiro Yamaguchi⁴, Masaaki Ito⁵, Fumio Ishida⁶, Jun Watanabe⁷, Daisuke Yamamoto⁸, Hiroaki Iijima¹, Shigeki Yamaguchi⁹, Masafumi Inomata³, Yoshiharu Sakai¹⁰, Takeshi Naitoh¹¹, Akinobu Taketomi¹

Affiliations

¹ From the Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
² Department of Surgery, Kyoto University Hospital, Kyoto, Japan.
³ Department of Gastroenterological and Pediatric Surgery, Oita University, Oita, Japan.
⁴ Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
⁵ Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
⁶ Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
⁷ Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
⁸ Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
⁹ Department of Gastroenterological Surgery, Tokyo Women's Medical University, Tokyo, Japan.
¹⁰ Department of Gastroenterological Surgery, Japan Red Cross Osaka Hospital, Osaka, Japan.
¹¹ Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan.

Abstract

Objective: This cohort study investigated short- and long-term postoperative outcomes of laparoscopic procedures for rectal cancer performed with versus without certified surgeons.

Background: In Japan, the Endoscopic Surgical Skill Qualification System (ESSQS) evaluates surgical skills deemed essential for laparoscopic surgery; however, it is unknown whether this certification contributes to procedural safety.

Methods: Outcomes of laparoscopic rectal resections for cStage II and III rectal cancer performed from 2014 to 2016 at 56 Japanese hospitals were retrospectively reviewed. The impact of having versus not having certified surgeons on postoperative complications and other short- and long-term outcomes were assessed. In cases with ESSQS-certified surgeons, surgeons attended surgery in the capacity of an operator, assistant, scope operator, or advisor.

Results: Overall, 3188 procedures were analyzed, with 2644 procedures performed with and 544 without ESSQS-certified surgeons. A multivariate logistic regression model showed that the adjusted odds ratio of postoperative complications after procedures performed with ESSQS-certified surgeons was 0.68 (95% confidence interval, 0.51-0.91; P = 0.009). The adjusted odds ratios for conversion and pathological R0 resection rates with ESSQS-certified surgeons were 0.20 (P < 0.001) and 2.10 (P = 0.04), respectively. Multiple linear regression analyses showed significantly shorter surgical duration and more harvested lymph nodes for operations performed with ESSQS-certified surgeons. Multivariate Cox regression showed that the adjusted hazard ratios for poor overall and recurrence-free survival after operations performed with ESSQS-certified surgeons were 0.88 (P = 0.35) and 1.04 (P = 0.71), respectively.

Conclusions: This study showed the superiority of the short-term postoperative results for laparoscopic rectal procedures performed with ESSQS-certified surgeons.

Keywords: laparoscopic; rectal cancer; safety; technical qualification.