Learning Curves of Ivor Lewis Totally Minimally Invasive Esophagectomy by Hospital and Surgeon Characteristics: A Retrospective Multinational Cohort Study

Linda Claassen*, Gerjon Hannink, Misha D P Luyer, Alan P Ainsworth, Mark I van Berge Henegouwen, Edward Cheong, Freek Daams, Marc J van Det, Peter van Duijvendijk, Suzanne S Gisbertz, Christian A Gutschow, Joos Heisterkamp, Juha T Kauppi, Bastiaan R Klarenbeek, Ewout A Kouwenhoven, Barbara S Langenhoff, Michael H Larsen, Ingrid S Martijnse, Ernst Jan van Nieuwenhoven, Donald L van der PeetJean-Pierre E N Pierie, Robert E G J M Pierik, Fatih Polat, Jari V Rusanen, Ioannis Rouvelas, Meindert N Sosef, Eelco B Wassenaar, Frits J H van den Wildenberg, Edwin S van der Zaag, Magnus Nilsson, Grard A P Nieuwenhuijzen, Frans van Workum, Camiel Rosman, Esophagectomy Learning Curve Collaborative Group

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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Abstract

OBJECTIVE: To describe the pooled learning curves of Ivor Lewis totally minimally invasive esophagectomy (TMIE) in hospitals stratified by predefined hospital- and surgeon-related factors.

BACKGROUND: Ivor Lewis (TMIE is known to have a long learning curve which is associated with considerable learning associated morbidity. It is unknown whether hospital and surgeon characteristics are associated with more efficient learning.

METHODS: A retrospective analysis of prospectively collected data of consecutive Ivor Lewis TMIE patients in 14 European hospitals was performed. Outcome parameters used as proxy for efficient learning were learning curve length, learning associated morbidity, and the plateau level regarding anastomotic leakage and textbook outcome. Pooled incidences were plotted for the factor-based subgroups using generalized additive models and 2-phase models. Casemix predicted outcomes were plotted and compared with observed outcomes. The investigated factors included annual volume, TMIE experience, clinic visits, courses and fellowships followed, and proctor supervision.

RESULTS: This study included 2121 patients. The length of the learning curve was shorter for centers with an annual volume >50 compared to centers with an annual volume <50. Analysis with an annual volume cut-off of 30 cases showed similar but less pronounced results. No outcomes suggesting more efficient learning were found for longer experience as consultant, visiting an expert clinic, completing a minimally invasive esophagectomy fellowship or implementation under proctor supervision.

CONCLUSIONS: More efficient learning was observed in centers with higher annual volume. Visiting an expert clinic, completing a fellowship, or implementation under a proctor's supervision were not associated with more efficient learning.

Original languageEnglish
JournalAnnals of Surgery
Volume275
Issue number5
Pages (from-to)911-918
ISSN0003-4932
DOIs
Publication statusPublished - 1. May 2022

Keywords

  • Cohort Studies
  • Esophageal Neoplasms/complications
  • Esophagectomy/methods
  • Hospitals
  • Humans
  • Laparoscopy/methods
  • Learning Curve
  • Minimally Invasive Surgical Procedures/methods
  • Postoperative Complications/epidemiology
  • Retrospective Studies
  • Surgeons
  • Treatment Outcome
  • learning curves
  • Ivor Lewis totally minimally invasive esophagectomy
  • efficient learning

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