Effect of endoscopic surgical skill qualification system for laparoscopic multivisceral resection: Japanese multicenter analysis

Abstract

The efficacy of laparoscopic multivisceral resection (Lap-MVR) has been reported by several experienced high-volume centers. The Endoscopic Surgical Skill Qualification System (ESSQS) was established in Japan to improve the skill of laparoscopic surgeons and further develop surgical teams. We examined the safety and feasibility of Lap-MVR in general hospitals, and evaluated the effects of the Japanese ESSQS for this approach. We retrospectively reviewed 131 patients who underwent MVR between April 2016 and December 2019. Patients were divided into the laparoscopic surgery group (LAC group, n\u2009=\u200998) and the open surgery group (OPEN group, n\u2009=\u200933). The clinicopathological and surgical features were compared between the groups. Compared with the OPEN group, BMI was significantly higher (21.9 vs 19.3 kg/m2, p\u2009=\u20090.012) and blood loss was lower (55 vs 380 ml, p\u2009<\u20090.001) in the LAC group. Operation time, postoperative complications, and postoperative hospital stay were similar between the groups. ESSQS-qualified surgeons tended to select the laparoscopic approach for MVR (p\u2009<\u20090.001). In the LAC group, ESSQS-qualified surgeons had superior results to those without ESSQS qualifications in terms of blood loss (63 vs 137 ml, p\u2009=\u20090.042) and higher R0 resection rate (0% vs 2.0%, p\u2009=\u20090.040), despite having more cases of locally advanced tumor. In addition, there were no conversions to open surgery among ESSQS-qualified surgeons, and three conversions among surgeons without ESSQS qualifications (0% vs 15.0%, p\u2009=\u20090.007). Multivariate analysis revealed blood loss (odds ratio 1.821; 95% CI 1.324–7.654; p\u2009=\u20090.010) as an independent predictor of postoperative complications. Laparoscopic approach was not a predictive factor. The present multicenter study confirmed the feasibility and safety of Lap-MVR even in general hospitals, and revealed superior results for ESSQS-qualified surgeons.