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Claassen L, Hannink G, Luyer MDP, et al. Learning Curves of Ivor Lewis Totally Minimally Invasive Esophagectomy by Hospital and Surgeon Characteristics: A Retrospective Multi-National Cohort Study. Ann Surg. 2021;doi: 10.1097/SLA.0000000000004801.
Claassen, L., Hannink, G., Luyer, M. D. P., Ainsworth, A. P., van Berge Henegouwen, M. I., Cheong, E., Daams, F., van Det, M. J., van Duijvendijk, P., Gisbertz, S. S., Gutschow, C. A., Heisterkamp, J., Kauppi, J. T., Klarenbeek, B. R., Kouwenhoven, E. A., Langenhoff, B. S., Larsen, M. H., Martijnse, I. S., van Nieuwenhoven, E. J., van der Peet, D. L., Pierie, J. E. N., Pierik, R. E. G. J. M., Polat, F., Räsänen, J. V., Rouvelas, I., Sosef, M. N., Wassenaar, E. B., van den Wildenberg, F. J. H., van der Zaag, E. S., Nilsson, M., Nieuwenhuijzen, G. A. P., van Workum, F., Rosman, C. (2021). Learning Curves of Ivor Lewis Totally Minimally Invasive Esophagectomy by Hospital and Surgeon Characteristics: A Retrospective Multi-National Cohort Study. Annals of surgery, . https://doi.org/10.1097/SLA.0000000000004801
Claassen, Linda, et al. "Learning Curves of Ivor Lewis Totally Minimally Invasive Esophagectomy by Hospital and Surgeon Characteristics: A Retrospective Multi-National Cohort Study." Annals of surgery vol. (2021). doi: https://doi.org/10.1097/SLA.0000000000004801
Claassen L, Hannink G, Luyer MDP, Ainsworth AP, van Berge Henegouwen MI, Cheong E, Daams F, van Det MJ, van Duijvendijk P, Gisbertz SS, Gutschow CA, Heisterkamp J, Kauppi JT, Klarenbeek BR, Kouwenhoven EA, Langenhoff BS, Larsen MH, Martijnse IS, van Nieuwenhoven EJ, van der Peet DL, Pierie JEN, Pierik REGJM, Polat F, Räsänen JV, Rouvelas I, Sosef MN, Wassenaar EB, van den Wildenberg FJH, van der Zaag ES, Nilsson M, Nieuwenhuijzen GAP, van Workum F, Rosman C. Learning Curves of Ivor Lewis Totally Minimally Invasive Esophagectomy by Hospital and Surgeon Characteristics: A Retrospective Multi-National Cohort Study. Ann Surg. 2021 Feb 10; doi: 10.1097/SLA.0000000000004801. Epub 2021 Feb 10. PMID: 33605581.
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Ann Surg. 2021 Feb 10; doi: 10.1097/SLA.0000000000004801. Epub 2021 Feb 10.

Learning Curves of Ivor Lewis Totally Minimally Invasive Esophagectomy by Hospital and Surgeon Characteristics: A Retrospective Multi-National Cohort Study.

Annals of surgery

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 Peet, Jean-Pierre E N Pierie, Robert E G J M Pierik, Fatih Polat, Jari V Räsänen, 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,

Affiliations

  1. Department of Surgery, Radboudumc, Nijmegen, The Netherlands Department of Operating Rooms, Radboudumc, Nijmegen, the Netherlands Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands Amsterdam UMC, location AMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands Department of Surgery, Gelre Ziekenhuizen, Apeldoorn, The Netherlands Division of Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital and Helsinki University Department of Surgery, medical Centre Leeuwarden, Leeuwarden, The Netherlands Department of UGI Surgery, Norfolk and Norwich University Hospital Foundation Trust, Norwich, UK Department of Surgery, Odense University Hospital, Denmark Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, The Netherlands Department of Surgery, Hospital Group Twente, Almelo, The Netherlands Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands Department of Surgery and Cancer, Imperial College London, London, United Kingdom.

PMID: 33605581 DOI: 10.1097/SLA.0000000000004801

Abstract

OBJECTIVE: To describe the pooled learning curves of Ivor Lewis TMIE in hospitals stratified by predefined hospital and surgeon related factors.

SUMMARY BACKGROUND DATA: Ivor Lewis totally minimally invasive esophagectomy (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 two-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 MIE 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.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Conflict of interest statement

Conflicts of interest and source of funding: No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. No funds we

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