Journal Article

Impact of the endoscopic surgical skill qualification system on conversion to laparotomy after low anterior resection for rectal cancer in Japan (a secondary analysis of the EnSSURE study)

Ochiai, Hiroki, Mizushima, Tsunekazu, Bando, Hiroyuki, Akagi, Yoshito, Mori, Shinichiro, Nagasaki, Toshiya, Ogawa, Hiroomi, Takehara, Kazuhiro, Fujiwara, Toshiyoshi, Taketomi, Akinobu, Ito, Masaaki, Takahashi, Shusaku, Ono, Tatsunori, Nagakari, Kunihiko, Ishii, Yoshiyuki, Naitoh, Takeshi, Kanazawa, Akiyoshi, Kurose, Yohei, Hida, Koya, Oshima, Ryuichi, Yamaguchi, Tomohiro, Ikeda, Koji, Saito, Shuji, Okamoto, Ken, Inomata, Masafumi, Shonaka, Tatsuya, Ikeshima, Ryo, Takata, Manabu, Takeshita, Hiroaki, Miura, Takuya, Shimamura, Tsukasa, Aisu, Naoya, Teraishi, Fuminori, Numata, Masakatsu, Munemoto, Yoshinori, Otsuka, Koki, Osawa, Hideki, Takatsuki, Mitsuhisa, Ohnuma, Shinobu, Ota, Hirofumi, Rino, Yasushi, Sakai, Yoshiharu, Iseki, Yasuhito, Kita, Yoshiaki, Homma, Shigenori, Ide, Yoshihito, Shiozawa, Manabu, Goto, Koki, Inoue, Yuji, Ozawa, Heita, Asahara, Fumitaka, Munakata, Koji, Kinjo, Tatsuya, Ichikawa, Nobuki, Kojima, Shigehiro, Takeda, Sho, Sasaki, Takahiro, Saeki, Hiroshi, Suwa, Yusuke, Sawada, Naruhiko, Matsuda, Takeru, Maruyama, Satoshi, Kimura, Toshimoto, Iijima, Hiroaki, Yamanashi, Takahiro, Furutani, Akinobu, K

2024

Overview

Background and aimsConversion to laparotomy is among the serious intraoperative complications and carries an increased risk of postoperative complications. In this cohort study, we investigated whether or not the Endoscopic Surgical Skill Qualification System (ESSQS) affects the conversion rate among patients undergoing laparoscopic surgery for rectal cancer.MethodsWe performed a retrospective secondary analysis of data collected from patients undergoing laparoscopic surgery for cStage II and III rectal cancer from 2014 to 2016 across 56 institutions affiliated with the Japan Society of Laparoscopic Colorectal Surgery. Data from the original EnSSURE study were analyzed to investigate risk factors for conversion to laparotomy by performing univariate and multivariate analyses based on the reason for conversion.ResultsData were collected for 3,168 cases, including 65 (2.1%) involving conversion to laparotomy. Indicated conversion accounted for 27 cases (0.9%), while technical conversion accounted for 35 cases (1.1%). The multivariate analysis identified the following independent risk factors for indicated conversion to laparotomy: tumor diameter [mm] (odds ratio [OR] 1.01, 95% confidence interval [CI] 1.01–1.05, p = 0.0002), combined resection of adjacent organs [+/−] (OR 7.92, 95% CI 3.14–19.97, p < 0.0001), and surgical participation of an ESSQS-certified physician [−/+] (OR 4.46, 95% CI 2.01–9.90, p = 0.0002). The multivariate analysis identified the following risk factors for technical conversion to laparotomy: registered case number of institution (OR 0.99, 95% CI 0.99–1.00, p = 0.0029), institution type [non-university/university hospital] (OR 3.52, 95% CI 1.54–8.04, p = 0.0028), combined resection of adjacent organs [+/−] (OR 5.96, 95% CI 2.15–16.53, p = 0.0006), and surgical participation of an ESSQS-certified physician [−/+] (OR 6.26, 95% CI 3.01–13.05, p < 0.0001).ConclusionsParticipation of ESSQS-certified physicians may reduce the risk of both indicated and technical conversion. Referral to specialized institutions, such as high-volume centers and university hospitals, especially for patients exhibiting relevant background risk factors, may reduce the risk of conversion to laparotomy and lead to better outcomes for patients.Trial RegistrationThis study was registered with the Japanese Clinical Trials Registry as UMIN000040645.

• Publisher: Springer Nature B.V
• Subject: Colorectal cancer / Endoscopy / Laparoscopy / Laparotomy / Multivariate analysis / Risk factors / Surgery