Surgical endoscopy · 2026
Learning curve and perioperative outcomes: a retrospective cohort study between synchronous and combined inflatable mediastinoscope-laparoscopic radical esophagectomy.
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Wei Hai-Tao, Xu Nuo, Zhao Zu-Yuan, Li Xia-Peng, Hu Bao-Li, Wang Jiao, Li Li, Long Qian
Аннотация
OBJECTIVE: To characterize the learning curve of inflatable mediastinoscope-assisted synchronous laparoscopic esophagectomy and to compare perioperative outcomes between synchronous and combined approaches.
METHODS: A retrospective analysis was performed on the clinical data of 229 consecutive patients who underwent minimally invasive radical esophagectomy in the Department of Thoracic Surgery between January 2018 and December 2020. All patients were divided into the synchronous group (n = 118) and the combined group (n = 111), and after 1:1 propensity score matching, 106 patients were successfully matched in each group for final analysis. The cumulative sum (CUSUM) method was used to construct learning curves for both the synchronous and combined groups based on operative time, and learning phases were identified according to inflection points, dividing it into initial, plateau, and proficiency phases based on inflection points. Baseline characteristics, perioperative indicators (operative time, intraoperative blood loss, etc.), postoperative complications, and short-term outcomes were compared between the overall groups and across learning phases within the synchronous group.
RESULTS: Baseline characteristics were balanced and comparable between the two groups (P > 0.05). Overall, the synchronous group demonstrated significantly superior outcomes compared to the combined group in terms of operative time, intraoperative blood loss, postoperative drainage volume at 3 days, total lymph node yield, time to first flatus, time to first ambulation, and postoperative hospital stay (P < 0.05). The CUSUM learning curve equation for the synchronous group was Y = - 0.001x3-0.146x2 + 30.865x-80.301 (R2 = 0.987), with inflection points at the 40th and 70th cases. Dividing the learning curve into the initial phase (cases 1-40), stabilization phase (cases 41-70), and proficiency phase (cases 71-106). As learning progressed, the synchronous group demonstrated significant improvements in operative time, blood loss, drainage volume, lymph node dissection rate, time to ambulation, and length of hospital stay (P < 0.05). Furthermore, the overall complication rate during the proficiency phase was significantly lower than that during the initial phase (P < 0.05).
CONCLUSION: Compared with the sequential combined inflatable mediastinoscope-assisted laparoscopic approach, the synchronous approach was associated with improved perioperative outcomes, fewer pulmonary complications, and a favorable learning trajectory in this retrospective cohort. These findings support its feasibility as an alternative minimally invasive strategy, although further prospective multicenter studies are required for validation.
METHODS: A retrospective analysis was performed on the clinical data of 229 consecutive patients who underwent minimally invasive radical esophagectomy in the Department of Thoracic Surgery between January 2018 and December 2020. All patients were divided into the synchronous group (n = 118) and the combined group (n = 111), and after 1:1 propensity score matching, 106 patients were successfully matched in each group for final analysis. The cumulative sum (CUSUM) method was used to construct learning curves for both the synchronous and combined groups based on operative time, and learning phases were identified according to inflection points, dividing it into initial, plateau, and proficiency phases based on inflection points. Baseline characteristics, perioperative indicators (operative time, intraoperative blood loss, etc.), postoperative complications, and short-term outcomes were compared between the overall groups and across learning phases within the synchronous group.
RESULTS: Baseline characteristics were balanced and comparable between the two groups (P > 0.05). Overall, the synchronous group demonstrated significantly superior outcomes compared to the combined group in terms of operative time, intraoperative blood loss, postoperative drainage volume at 3 days, total lymph node yield, time to first flatus, time to first ambulation, and postoperative hospital stay (P < 0.05). The CUSUM learning curve equation for the synchronous group was Y = - 0.001x3-0.146x2 + 30.865x-80.301 (R2 = 0.987), with inflection points at the 40th and 70th cases. Dividing the learning curve into the initial phase (cases 1-40), stabilization phase (cases 41-70), and proficiency phase (cases 71-106). As learning progressed, the synchronous group demonstrated significant improvements in operative time, blood loss, drainage volume, lymph node dissection rate, time to ambulation, and length of hospital stay (P < 0.05). Furthermore, the overall complication rate during the proficiency phase was significantly lower than that during the initial phase (P < 0.05).
CONCLUSION: Compared with the sequential combined inflatable mediastinoscope-assisted laparoscopic approach, the synchronous approach was associated with improved perioperative outcomes, fewer pulmonary complications, and a favorable learning trajectory in this retrospective cohort. These findings support its feasibility as an alternative minimally invasive strategy, although further prospective multicenter studies are required for validation.