title: Laparoscopic resection for sigmoid and rectosigmoid colon cancer performed by trainees: impact on short-term outcomes and selection of suitable patients.
abstract: OBJECTIVE
  This study aimed (1) to evaluate the impact of clinical factors, particularly operation by trainees, on the short-term outcomes of laparoscopic resection for sigmoid and rectosigmoid cancer, and (2) to determine patients suitable for operation by trainees.
  
  
  METHODS
  From a prospectively maintained single-institution database, we identified 133 patients who underwent laparoscopic resection for sigmoid or rectosigmoid cancer between 2007 and 2010. Gender, age, body mass index (BMI), previous abdominal surgery, tumor location, tumor size, tumor stage, extent of lymph node dissection, and primary surgeon were evaluated using univariate and multivariate analyses to determine the predictive significance of these variables on surgical outcomes including operative time, blood loss, complication, postoperative stay, and retrieved lymph nodes.
  
  
  RESULTS
  Multivariate analysis showed that location of the tumor in the rectosigmoid (p < 0.001), higher BMI (p < 0.001), operation by trainees (p < 0.001), male gender (p = 0.002), and greater tumor depth (p = 0.011) were independently predictive of longer operative time. Larger tumor size (p = 0.025) and higher BMI (p = 0.040) were independently predictive of greater blood loss. Larger tumor size was also related to longer postoperative stay (p = 0.001) and a greater number of retrieved lymph nodes (p = 0.001).
  
  
  CONCLUSIONS
  This study identified operation by trainees as an independent risk factor for longer operative time but with no negative impact on any of the other outcomes. Female patients with a low BMI, sigmoid cancer, shallow tumor depth, and/or small tumor are suitable for operation by trainees.
authors.affiliation: Department of Surgery, Kyoto Medical Center, Fukakusa, Fushimi-ku, Kyoto, Japan. oggy_so@ybb.ne.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ogiso
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Meiki
authors.initials: M
authors.lastname: Fukuda
authors.forename: Takahide
authors.initials: T
authors.lastname: Murakami
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Okuchi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Hata
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Sakai
authors.forename: Iwao
authors.initials: I
authors.lastname: Ikai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D012809:Colon, Sigmoid / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000193:education*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012811:Sigmoid Neoplasms / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome