腹腔鏡補助下及びロボット支援下直腸切除術のlearning curve形成期における難易度因子の検討
直腸癌手術は比較的難易度の高い手技であり，修練初期に安全に行うために，患者選択を慎重に行う必要がある．本研究では，腹腔鏡補助下直腸手術（laparoscopic-assisted rectal surgery, LARS）とロボット支援下直腸手術（robotic-assisted rectal surgery, RARS）のlearning curve形成期に適した患者選択の指標を目的に，患者背景，画像所見と手術成績から，難易度に関わる因子を検討した．多変量解析では，LARSは血管結紮位置，骨盤入口径，腹部内臓脂肪面積，骨盤容積，RARSは直腸容積が難易度因子として抽出された．手術法による交互...
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| Published in | 岩手医学雑誌 Vol. 73; no. 2; pp. 63 - 72 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
岩手医学会
01.06.2021
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| Abstract | 直腸癌手術は比較的難易度の高い手技であり，修練初期に安全に行うために，患者選択を慎重に行う必要がある．本研究では，腹腔鏡補助下直腸手術（laparoscopic-assisted rectal surgery, LARS）とロボット支援下直腸手術（robotic-assisted rectal surgery, RARS）のlearning curve形成期に適した患者選択の指標を目的に，患者背景，画像所見と手術成績から，難易度に関わる因子を検討した．多変量解析では，LARSは血管結紮位置，骨盤入口径，腹部内臓脂肪面積，骨盤容積，RARSは直腸容積が難易度因子として抽出された．手術法による交互作用の検討では，LARSと比較しRARSで直腸容積が有意に難易度を上げる因子となっていた．他の多くの因子でLARSとRARSの回帰直線が正負逆の傾きを示す結果となり，ロボット支援下手術では腹腔鏡下手術とは違った教育プログラム構築の必要性が示唆された． |
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| AbstractList | 直腸癌手術は比較的難易度の高い手技であり，修練初期に安全に行うために，患者選択を慎重に行う必要がある．本研究では，腹腔鏡補助下直腸手術（laparoscopic-assisted rectal surgery, LARS）とロボット支援下直腸手術（robotic-assisted rectal surgery, RARS）のlearning curve形成期に適した患者選択の指標を目的に，患者背景，画像所見と手術成績から，難易度に関わる因子を検討した．多変量解析では，LARSは血管結紮位置，骨盤入口径，腹部内臓脂肪面積，骨盤容積，RARSは直腸容積が難易度因子として抽出された．手術法による交互作用の検討では，LARSと比較しRARSで直腸容積が有意に難易度を上げる因子となっていた．他の多くの因子でLARSとRARSの回帰直線が正負逆の傾きを示す結果となり，ロボット支援下手術では腹腔鏡下手術とは違った教育プログラム構築の必要性が示唆された． |
| Author | 佐々木, 章 中村, 侑哉 八重樫, 瑞典 大塚, 幸喜 松尾, 鉄平 木村, 聡元 |
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Park EJ, Kim CW, Cho MS, et al.: Multidimensional analyses of the learning curve of robotic low anterior resection for rectal cancer: 3-phase learning process comparison. Surg Endosc 28, 2821-2831, 2010. Yamaoka Y, Yamaguchi T, Kinugasa Y, et al.: Mesorectal fat area as a useful predictor of the difficulty of roboticassisted laparoscopic total mesorectal excision for rectal cancer. Surg Endosc 33, 557-566, 2019. Park IJ, Choi GS, Lim KH, et al.: Multidimensional analysis of the learning curve for laparoscopic resection in rectal cancer. J Gastrointest Surg 13, 275-281, 2009. Huang S, Chen M, Deng Y, et al.: Mesorectal fat area and mesorectal area affect the surgical difficulty of robotic‐assisted mesorectal excision and intersphincteric resection respectively in different ways. Col Dis 22, 1130-1138, 2020. Kim NK, Kim YW, Han YD, et al.: Complete mesocolic excision and central vascular ligation for colon cancer: Principle, anatomy, surgical technique, and outcomes. Surg Oncol 25, 252-262, 2016. Colon cancer laparoscopic or open resection study group: Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6, 477-484, 2005. Fleshman J, Sargent DJ, Green E, et al.: Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST study group trial. Ann Surg 246, 655-664, 2007. Kanda Y: Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48, 452-458, 2013. Fleshman J, Branda M, Sargent DJ, et al.: Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: The ACOSOG Z6051 randomized clinical trial. JAMA 314, 1346-1355, 2015. Hinoi T, Okajima M, Shinomura M, et al.: Effect of left colonic artery preservation on anastomotic leakage in laparoscopic anterior resection for middle and low rectal cancer. World J Surg 37, 2935–2943, 2013. Seki Y, Ohue M, Sekimoto M, et al.: Evaluation of the technical difficulty performing laparoscopic resection of a rectosigmoid carcinoma: visceral fat reflects technical difficulty more accurately than body mass index. Endosc 21, 929-934, 2007. Kazuhiro M: Applications of multiple regression analysis: analysis including interaction term and control variables. Bul Hijiyama Univ Jun Col 43, 69-73, 2007. Hasegawa H, Takahashi A, Kakeji Y, et al.: Surgical of gastroenterological surgery in Japan: Report of the national clinical database 2011-2017. Ann Gastroenterol Surg 3, 426-450, 2019. Lacy AM, García-Valdecasas JC, Delgado S, et al.: Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359, 2224-2229, 2002. Yamaguchi T, Kinugasa Y, Shiomi A, et al.: Learning curve for robotic-assisted surgery for rectal cancer: use of the cumulative sum method. Surg Endosc 29, 1679-1685, 2015. Roy S and Evans C: Overview of robotic colorectal surgery: Current and future practical developments. World J Gastrointest Surg 27, 143-150, 2016. Odarmatt M, Ahmed J, Panteleimonitis S, et al.: Prior experience in laparoscopic rectal surgery can minimise the learning curve for robotic rectal resections: a cumulative sum analysis. Surg Endosc 31, 4067-4076, 2017. Jayne DG, Guillou PJ, Thorpe H, et al.: Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC trial group. J Clin Oncol 25, 3061-3068, 2007. Stevenson ARL, Solomon MJ, Lumley JW, et al.: Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: The ALaCaRT randomized clinical trial. JAMA 314, 1356-1363, 2015. Japanese society for cancer of the colon and rectum: Japanese classification of colorectal, appendiceal, and anal carcinoma, 9th ed, Kanehara Publishing Co, Tokyo, 2018. The colon cancer laparoscopic or open resection study group: Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10, 44-52, 2009. Ito M, Sugito M, Kobayashi A, et al.: Influence of learning curve on short-term results after laparoscopic resection for rectal cancer. Surg Endosc 23, 403-408, 2009. Hatanaka T, Otsuka K, Kimura S, et al.: Evaluation of factors affecting difficulty of laparoscopic low anterior resection. JIMA 70, 39-48, 2018. Bege T, Lelong B, Esterni B, et al.: The learning curve for the laparoscopic approach to conservative mesorectal excision for rectal cancer. Ann Surg 251, 249-253, 2010. |
| References_xml | – reference: Bege T, Lelong B, Esterni B, et al.: The learning curve for the laparoscopic approach to conservative mesorectal excision for rectal cancer. Ann Surg 251, 249-253, 2010. – reference: Fleshman J, Branda M, Sargent DJ, et al.: Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: The ACOSOG Z6051 randomized clinical trial. JAMA 314, 1346-1355, 2015. – reference: Jayne DG, Guillou PJ, Thorpe H, et al.: Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC trial group. J Clin Oncol 25, 3061-3068, 2007. – reference: Guillou PJ, Quirke P, Thorpe H, et al.: Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365, 1718-1726, 2005. – reference: Kim NK, Kim YW, Han YD, et al.: Complete mesocolic excision and central vascular ligation for colon cancer: Principle, anatomy, surgical technique, and outcomes. Surg Oncol 25, 252-262, 2016. – reference: Kazuhiro M: Applications of multiple regression analysis: analysis including interaction term and control variables. Bul Hijiyama Univ Jun Col 43, 69-73, 2007. – reference: Zhou XC, Su M, Hu KQ, et al.: CT pelvimetry and clinicopathological parameters in evaluation of the technical difficulties in performing open rectal surgery for mid-low rectal cancer. Oncol lett 11, 31-38, 2016. – reference: Fleshman J, Sargent DJ, Green E, et al.: Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST study group trial. Ann Surg 246, 655-664, 2007. – reference: Yamaguchi T, Kinugasa Y, Shiomi A, et al.: Learning curve for robotic-assisted surgery for rectal cancer: use of the cumulative sum method. Surg Endosc 29, 1679-1685, 2015. – reference: Seki Y, Ohue M, Sekimoto M, et al.: Evaluation of the technical difficulty performing laparoscopic resection of a rectosigmoid carcinoma: visceral fat reflects technical difficulty more accurately than body mass index. Endosc 21, 929-934, 2007. – reference: Hinoi T, Okajima M, Shinomura M, et al.: Effect of left colonic artery preservation on anastomotic leakage in laparoscopic anterior resection for middle and low rectal cancer. World J Surg 37, 2935–2943, 2013. – reference: Ito M, Sugito M, Kobayashi A, et al.: Influence of learning curve on short-term results after laparoscopic resection for rectal cancer. Surg Endosc 23, 403-408, 2009. – reference: Park EJ, Kim CW, Cho MS, et al.: Multidimensional analyses of the learning curve of robotic low anterior resection for rectal cancer: 3-phase learning process comparison. Surg Endosc 28, 2821-2831, 2010. – reference: Yamaoka Y, Yamaguchi T, Kinugasa Y, et al.: Mesorectal fat area as a useful predictor of the difficulty of roboticassisted laparoscopic total mesorectal excision for rectal cancer. Surg Endosc 33, 557-566, 2019. – reference: Lacy AM, García-Valdecasas JC, Piqué JM, et al.: Short-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer. Surg Endosc 9, 1101-1105, 1995. – reference: Stevenson ARL, Solomon MJ, Lumley JW, et al.: Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: The ALaCaRT randomized clinical trial. JAMA 314, 1356-1363, 2015. – reference: Hatanaka T, Otsuka K, Kimura S, et al.: Evaluation of factors affecting difficulty of laparoscopic low anterior resection. JIMA 70, 39-48, 2018. – reference: Kanda Y: Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48, 452-458, 2013. – reference: Lacy AM, García-Valdecasas JC, Delgado S, et al.: Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359, 2224-2229, 2002. – reference: Park IJ, Choi GS, Lim KH, et al.: Multidimensional analysis of the learning curve for laparoscopic resection in rectal cancer. J Gastrointest Surg 13, 275-281, 2009. – reference: Huang S, Chen M, Deng Y, et al.: Mesorectal fat area and mesorectal area affect the surgical difficulty of robotic‐assisted mesorectal excision and intersphincteric resection respectively in different ways. Col Dis 22, 1130-1138, 2020. – reference: Clinical outcomes of surgical therapy study group: A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350, 2050-2059, 2004. – reference: Kayano H, Okuda J, Tanaka K, et al.: Evaluation of the learning curve in laparoscopic low anterior resection for rectal cancer. Surg Endosc 25, 2972-2979, 2011. – reference: Japanese society for cancer of the colon and rectum: Japanese classification of colorectal, appendiceal, and anal carcinoma, 9th ed, Kanehara Publishing Co, Tokyo, 2018. – reference: Colon cancer laparoscopic or open resection study group: Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6, 477-484, 2005. – reference: Hasegawa H, Takahashi A, Kakeji Y, et al.: Surgical of gastroenterological surgery in Japan: Report of the national clinical database 2011-2017. Ann Gastroenterol Surg 3, 426-450, 2019. – reference: The colon cancer laparoscopic or open resection study group: Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10, 44-52, 2009. – reference: Roy S and Evans C: Overview of robotic colorectal surgery: Current and future practical developments. World J Gastrointest Surg 27, 143-150, 2016. – reference: Odarmatt M, Ahmed J, Panteleimonitis S, et al.: Prior experience in laparoscopic rectal surgery can minimise the learning curve for robotic rectal resections: a cumulative sum analysis. Surg Endosc 31, 4067-4076, 2017. |
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| Title | 腹腔鏡補助下及びロボット支援下直腸切除術のlearning curve形成期における難易度因子の検討 |
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