Journal of minimal access surgery · 2026
Enhancing lymph node harvest in hemicolectomies: A before-and-after study of surgical preceptorship and audit feedback.
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Arora Prateek, Tilloo Raviraj, Konda Sujitha Reddy, Ahmed Zeeshan, Patil Sanjeev M, Sekaran Anuradha, Rebala Pradeep, Rao G V
Аннотация
INTRODUCTION: Adequate lymph node (LN) retrieval is a key quality indicator in oncological colon surgery, with ≥12 LNs considered the benchmark for high-yield lymphadenectomy. Variability in surgical performance, particularly amongst early-career surgeons, can impact oncological outcomes. This study evaluates the impact of surgical preceptorship on LN yield in radical hemicolectomies through a before-and-after cohort analysis as part of a complete audit cycle.
PATIENTS AND METHODS: A retrospective audit was conducted at a tertiary care centre, analysing 99 radical hemicolectomies performed between February and November 2022. The primary objective was to assess the mean LN yield and proportion of cases achieving high-yield lymphadenectomy. Following analysis, a structured surgical preceptorship programme involving didactic sessions, hands-on training and standard operating protocols was implemented. A re-audit of 114 hemicolectomies performed between April and September 2023 was then conducted. Data were compared between pre- and post-intervention groups, including subgroup analyses for senior and junior consultants and open versus laparoscopic procedures.
RESULTS: The mean LN yield significantly improved from 15.4 ± 7.8 to 17.5 ± 6.5 postintervention (P = 0.033). The proportion of high-yield cases increased from 69% to 80.7% (P = 0.06). While senior and junior consultants had similar LN yields postintervention, a statistically significant improvement was noted in the junior group alone (14.6-17.69, P = 0.014). No significant difference was observed between the open and laparoscopic groups.
CONCLUSION: Surgical preceptorship led to improved LN harvest across the team, particularly in junior consultants, demonstrating its effectiveness as a team-wide quality improvement tool beyond individual learning curves or surgical approach.
PATIENTS AND METHODS: A retrospective audit was conducted at a tertiary care centre, analysing 99 radical hemicolectomies performed between February and November 2022. The primary objective was to assess the mean LN yield and proportion of cases achieving high-yield lymphadenectomy. Following analysis, a structured surgical preceptorship programme involving didactic sessions, hands-on training and standard operating protocols was implemented. A re-audit of 114 hemicolectomies performed between April and September 2023 was then conducted. Data were compared between pre- and post-intervention groups, including subgroup analyses for senior and junior consultants and open versus laparoscopic procedures.
RESULTS: The mean LN yield significantly improved from 15.4 ± 7.8 to 17.5 ± 6.5 postintervention (P = 0.033). The proportion of high-yield cases increased from 69% to 80.7% (P = 0.06). While senior and junior consultants had similar LN yields postintervention, a statistically significant improvement was noted in the junior group alone (14.6-17.69, P = 0.014). No significant difference was observed between the open and laparoscopic groups.
CONCLUSION: Surgical preceptorship led to improved LN harvest across the team, particularly in junior consultants, demonstrating its effectiveness as a team-wide quality improvement tool beyond individual learning curves or surgical approach.