“Surgeons were recruited from the Illinois Surgical Quality Improvement Collaborative in 2016 for a video-based technical skills assessment program.4 Each surgeon submitted 1 representative video of a laparoscopic right hemicolectomy that they performed. Videos were reviewed by 12 or more surgeons, including 2 colorectal surgeons with video evaluation experience. Skill scores were assigned using the American Society of Colon & Rectal Surgeons Video Assessment Tool, and the mean score from all raters was used. Skill score was analyzed separately by terciles and as a continuous variable.
Patients who underwent any minimally invasive colectomy for stage I to III epithelial-origin colon cancer were identified in the National Cancer Database. Patients with operations performed from 2012 to 2017 by participating surgeons were identified by National Provider Identifier numbers, which are maintained internally by the American College of Surgeons. The primary outcome was overall survival after surgery, and the secondary outcome was the number of lymph nodes harvested.
[..] In total, 609 patients underwent laparoscopic colectomy at 11 hospitals performed by 1 of 15 participating surgeons (9 colorectal [60%]; 6 general [40%]). Overall survival differed among skill terciles (5-year survival: 79% for high-skill, 55% for medium-skill, and 60% for low-skill; P = .01 for log-rank test). Adjusting for patient characteristics, survival was improved for the high-skill vs low-skill tercile (HR, 0.31; 95% CI, 0.18-0.54). Each 0.1-point skill score increment was associated with a higher likelihood of survival (HR, 0.90; 95% CI, 0.84-0.97). A sensitivity analysis excluding 90-day mortalities demonstrated similar results.
A stage-stratified sensitivity analysis demonstrated that the association between skill and outcomes was strongest among patients with stage II disease (high vs low skill: HR, 0.14; 95% CI, 0.07-0.30; middle vs low skill: HR, 0.12; 95% CI, 0.04-0.39; 0.1-point score increment: HR, 0.85; 95% CI, 0.78-0.94). In a sensitivity analysis of 307 open procedures, survival was improved for the high-skill (HR, 0.41; 95% CI, 0.18-0.90) and middle-skill (HR, 0.41; 95% CI, 0.23-0.72) vs the low-skill tercile; however, each 0.1-point skill score increment was not significantly associated with survival (HR, 0.91; 95% CI, 0.80-1.05). The mean (SD) number of lymph nodes examined was 23.9 (9.2) for the high-skill tercile, 21.2 (10.5) for the middle-skill tercile, and 20.3 (12.1) for the low-skill tercile, but terciles did not differ significantly on adjusted analysis.”
Full article, Brajcich BC, Stulberg JJ, Palis BE et al. JAMA Oncology 2020.10.30