Key result
Structured surgical training in minimally invasive esophagectomy allowed a trainee to achieve a significantly higher rate of textbook outcomes (40.66% vs 27.00%, p=0.046) compared to an experienced trainer after completing the learning curve of 83 cases.
Why the study?
This study aimed to delineate the learning curve associated with minimally invasive esophagectomy (MIE) and evaluate its impact on patient outcomes.
Does a structured surgical training program in minimally invasive esophagectomy allow trainees to achieve proficiency and textbook outcomes without compromising patient safety?
Cohort (n=191)
No
Does a structured surgical training program in minimally invasive esophagectomy allow trainees to achieve proficiency and textbook outcomes without compromising patient safety?
A structured surgical training program for minimally invasive esophagectomy allows trainees to achieve technical competence and textbook outcomes without compromising patient safety or oncological outcomes.
Answers are grounded in this paper and cite their sources.
Trainee competence in minimally invasive esophagectomy may be feasible without safety compromise; extends learning-curve data but leaves open generalizability.
BACKGROUND: Minimally Invasive Esophagectomy (MIE) is a complex surgical procedure that has become a cornerstone in the management of esophageal cancer. This study aims to delineate the learning curve associated with MIE and its impact on patient outcomes. METHODS: A retrospective analysis was conducted on 191 patients who underwent MIE between 2015 and 2022. The cohort was divided into two groups according to the level of competence: Trainer (n = 100) and Trainee (n = 91). Patient demographics, tumor characteristics, and surgical parameters were examined. RA-CUSUM methodology was employed to monitor patient outcomes, adjusting for variations in risk profiles using varying-coefficient logistic regression models to establish the MIE proficiency learning curve. RESULTS: The trainee achieved competence in terms of operative time within 47 cases, following risk adjustment. Similarly, the learning curve in terms of major complications was completed after the 55th consecutive case. The LC was completed in terms of increased incidence of TO achievement in the trainee group after 83 cases (Trainer vs. Trainee, 27.00% vs. 40.66%, p = 0.046). Anastomotic leakage (Trainer vs. Trainee, 10.00% vs. 7.69% (p = 0.575)) could be identified with consistent rates for both trainer and trainee during the observational period. Pulmonary complications accounted for the majority of complications. After a follow-up of 2 years, no effect of the learning curve on overall (p = 0.436) or disease-free (p = 0.305) survival could be concluded, indicating consistent quality and patient safety during the surgical training. CONCLUSIONS: While technical competence can be achieved after approximately 55 cases, achievement of 'textbook outcome' (TO) requires 83 cases. The findings demonstrate that structured surgical training can progress in tandem while maintaining oncological safety for patients. While technical competence is crucial, the ultimate goal should be achieving a TO.
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Seika et al. (2025) conducted a cohort in Esophageal cancer and cancer of the gastroesophageal junction (n=191). Minimally invasive esophagectomy performed by a trainee vs. Minimally invasive esophagectomy performed by an experienced trainer was evaluated on Textbook Outcome (TO) achievement (p=0.046). Structured surgical training in minimally invasive esophagectomy allowed a trainee to achieve a significantly higher rate of textbook outcomes (40.66% vs 27.00%, p=0.046) compared to an experienced trainer after completing the learning curve of 83 cases.
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