The Impact of a Modular Robotic Total Mesorectal Excision Training Program on Perioperative and Oncological Outcomes in Robotic Rectal Cancer Surgery

Abstract

BACKGROUND: Structured training programs for robotic colorectal surgery are limited, and there are concerns about surgical outcomes and operating times. OBJECTIVE: To compare perioperative and oncological outcomes of robotic total mesorectal excision for rectal cancer performed by expert consultants and surgical trainees in a modular surgical training program. DESIGN: Retrospective cohort study. SETTINGS: Conducted at a colorectal training referral center for robotic surgery. PATIENTS: Consecutive robotic total mesorectal excision cases between May 2013 and December 2017 were evaluated retrospectively from a prospectively maintained institutional database and divided into 2 groups: group I comprised expert surgeons and group II comprised supervised trainees. Robotic total mesorectal excision training modules (5 modules) were performed stepwise with increasing complexity. Patients' demographic, perioperative, and oncological data were collected. INTERVENTIONS: Modular robotic training. MAIN OUTCOME MEASURES: Comparable R0 resection rate, lymph node harvest, and oncological outcomes between experts and trainees, suggesting good quality in oncological resection. RESULTS: A total of 177 robotic total mesorectal excision resections were performed (group I: n = 80, group II: n = 97). Four trainees completed 37.5 modules each. Patients' age, sex, and BMI were similar between groups. Group II had a higher ASA III score (6.3% vs 25.8%, p = 0.002). Clinical TNM and neoadjuvant chemoradiotherapy rates were similar. Group II had a longer operative time (225 [197.5-297.5] vs 250 [230-300] minutes, p = 0.004). No conversion occurred. There were no differences in intra- or postoperative outcomes between groups. The rate of R0 resection and the number of harvested lymph nodes were also similar between groups. The median follow-up was 75 (64.0-81.7) and 47 (38.0-55.0) months, respectively. Local and distant recurrence rates, 5-year overall survival (81.1% group I vs 81.3% group II, p = 0.832), and 5-year disease-free survival (79.7% group I vs 80.7% group II, p = 0.725) were similar between groups. LIMITATIONS: The groups operated in 2 consecutive periods. CONCLUSIONS: The robotic total mesorectal excision modular surgical training program maximizes training experience without significantly affecting the perioperative and oncological outcomes of patients with rectal cancer. See Video Abstract. EL IMPACTO DEL PROGRAMA MODULAR DE ENTRENAMIENTO EN ESCISIN MESORRECTAL TOTAL ROBTICA EN LOS RESULTADOS PERIOPERATORIOS Y ONCOLGICOS EN LA CIRUGA ROBTICA DEL CNCER DE RECTO: ANTECEDENTES:Los programas de entrenamiento estructurados para la cirugía colorrectal robótica están limitados debido a preocupaciones sobre los resultados quirúrgicos y los tiempos de operación.OBJETIVO:Comparar los resultados perioperatorios y oncológicos de la escisión mesorrectal total robótica para el cáncer de recto realizada por consultores expertos y aprendices de cirugía en un programa modular de entrenamiento quirúrgica.DISEÑO:Estudio de cohorte retrospectivo.AJUSTES:Realizado en un centro de referencia de entrenamiento colorrectal para cirugía robótica.PACIENTES:Se evaluaron retrospectivamente casos consecutivos de escisión mesorrectal total robótica entre mayo de 2013 y diciembre de 2017 a partir de una base de datos institucional mantenida prospectivamente y se dividieron en dos grupos: Grupo I: cirujanos expertos; Grupo II: aprendices supervisados. Los módulos de entrenamiento robótico de escisión mesorrectal total (cinco módulos) se realizaron paso a paso con complejidad creciente. Se recogieron datos demográficos, perioperatorios y oncológicos.INTERVENCIONES:Entrenamiento modular en robótica.PRINCIPALES MEDIDAS DE RESULTADO:Tasa de resección R0 comparable, extracción de ganglios linfáticos y resultados oncológicos entre expertos y aprendices que sugieren buena calidad en la resección oncológica.RESULTADOS:Se realizaron un total de 177 resecciones por escisión mesorrec