1. Surgeon Quality Control and Standardization of D2 Lymphadenectomy for Gastric Cancer
- Author
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Sang-Uk Han, Hyuk-Joon Lee, Hoon Hur, Gyu Seok Cho, Woo Jin Hyung, Min Chan Kim, Young-Kyu Park, and Wook Kim
- Subjects
Adult ,Male ,Quality Control ,Laparoscopic surgery ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Gastrectomy ,Stomach Neoplasms ,law ,medicine ,Humans ,Prospective Studies ,Laparoscopy ,Prospective cohort study ,education ,Aged ,Randomized Controlled Trials as Topic ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,General surgery ,Middle Aged ,Clinical trial ,Treatment Outcome ,030220 oncology & carcinogenesis ,Lymph Node Excision ,Female ,030211 gastroenterology & hepatology ,Surgery ,Lymphadenectomy ,Clinical Competence ,business - Abstract
OBJECTIVE To qualify surgeons to participate in a randomized trial comparing laparoscopic and open distal D2 gastrectomy for advanced gastric cancer. SUMMARY OF BACKGROUND DATA No studies have sought to qualify surgeons for a randomized trial comparing laparoscopic and open D2 gastrectomy for advanced gastric cancer. METHODS We conducted a multicenter prospective observational study evaluating unedited videos of laparoscopic and open D2 gastrectomy performed by 27 surgeons. Surgeons performed 3 of each laparoscopic and open distal gastrectomies with D2 lymphadenectomy for gastric cancer. Five peers reviewed each unedited video using a video assessment form. Based on experts' review of videos, a separate review committee decided surgeons as "Qualified" or "Not-qualified." RESULTS Twelve surgeons (44.4%) were qualified on initial evaluation whereas the other 15 surgeons were not. Another 9 surgeons were finally qualified after re-evaluation. The median score for Qualified was significantly higher than Not-qualified (P < 0.001).Significant differences between Qualified and Not-qualified were noted both in operation type and in all evaluation area of surgical skill, perigastric, and extra-perigastric lymphadenectomy, although the inter-rater variability of the assessment score was low (kappa = 0.285). However, Not-qualified surgeons' scores improved upon re-evaluation of resubmitted videos.When compared laparoscopy with open surgery, median scores were similar between the 2 groups (P = 0.680). However, open gastrectomy scores for surgical skills were significantly higher than for laparoscopic surgery (P = 0.016). CONCLUSIONS Our surgeon quality control study for gastrectomy represents a milestone in surgical standardization for surgical clinical trials. Our methods could also serve as a system for educating surgeons and assessing surgical proficiency.
- Published
- 2020