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Learning curves in minimally invasive esophagectomy

World Journal of Gastroenterology 2018年第44期24卷 4974-4978页

作者： frans van workum Laura fransen Misha DP Luyer Camiel Rosman Department of Surgery Radboud University Medical Center Department of Surgery Catharina Hospital

Surgical innovation and pioneering are important for improving patient outcome, but can be associated with learning curves. Although learning curves in surgery are a recognized problem, the impact of surgical learning curves is increasing, due to increasing complexity of innovative surgical procedures, the rapid rate at which new interventions are implemented and a decrease in relative effectiveness of new interventions compared to old interventions. For minimally invasive esophagectomy(MIE), there is now robust evidence that implementation can lead to significant learning associated morbidity(morbidity during a learning curve, that could have been avoided if patients were operated by surgeons that have completed the learning curve). This article provides an overview of the evidence of the impact of learning curves after implementation of MIE. In addition, caveats for implementation and available evidence regarding factors that are important for safe implementation and safe pioneering of MIE are discussed.

关键词： Minimally invasive esophagectomy Learning curve Pioneering Safe implementation Profciency gain curve

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Outcomes of curative esophageal cancer surgery in elderly:A metaanalysis

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World Journal of Gastrointestinal Oncology 2021年第2期13卷 131-146页

作者： Nikolaj S Baranov Cettela Slootmans frans van workum Bastiaan R Klarenbeek Yvonne Schoon Camiel Rosman Department of Surgery Radboud University Medical CenterNijmegen 6525GAthe Netherlands Department of Geriatrics Radboud University Medical CenterNijmegen 6525GAthe Netherlands

BACKGROUND An increasing number of older patients is undergoing curative,surgical treatment of esophageal *** meta-analyses have shown that older patients suffered from more postoperative morbidity and mortality compared to younger patients,which may lead to patient selection based on ***,only studies including patients that underwent open esophagectomy were ***,it remains unknown whether there is an association between age and outcome in patients undergoing minimally invasive *** To perform a systematic review on age and postoperative outcome in esophageal cancer patients undergoing *** Studies comparing older with younger patients with primary esophageal cancer undergoing curative esophagectomy were ***-analysis of studies using a 75-year age threshold are presented in the manuscript,studies using other age thresholds in the Supplementary ***,Embase and the Cochrane Library were searched for articles published between 1995 and *** of bias was assessed with the Newcastle-Ottawa *** outcomes were anastomotic leak,pulmonary and cardiac complications,delirium,30-and 90-d,and in-hospital *** outcomes included pneumonia and 5-year overall *** Seven studies(4847 patients)using an age threshold of 75 years were included for meta-analysis with 755 older and 4092 younger *** patients(9.05%)had higher rates of 90-d mortality compared with younger patients(3.92%),(confidence interval=1.10-5.56).In addition,older patients(9.45%)had higher rates of in-hospital mortality compared with younger patients(3.68%),(confidence interval=1.01-5.91).In the subgroup of 2 studies with minimally invasive esophagectomy,older and younger patients had comparable 30-d,90-d and in-hospital mortality *** Older patients undergoing curative esophagectomy for esophageal cancer have a higher postoperative mortality *** invasive esopha

关键词： Elderly Minimally invasive esophagectomy Open esophagectomy Esophageal cancer Clinical outcome Perioperative mortality

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