title: Short- and mid-term outcomes after early surgical training in laparoscopic colorectal cancer surgery: trainees' performance has no negative impact.
abstract: BACKGROUND
  This study aimed to evaluate the safety and quality of laparoscopic colorectal cancer surgery undertaken by trainees.
  
  
  METHODS
  From a prospectively maintained database, we identified 456 consecutive patients who underwent laparoscopic resection for colorectal cancer between 2006 and 2010. Short-term operative outcomes, relapse-free survival (RFS), and overall survival (OS) were compared between operations undertaken by the experts (E group) and trainees (T group). Multivariate analyses were performed for RFS and OS in stage II/III disease.
  
  
  RESULTS
  Trainees performed 313 surgeries (68.6%) and completed the procedure by themselves in 297 cases (94.9%). Short-term outcomes, including operative time, blood loss, conversion, complication, mortality, and retrieval of less than 12 lymph nodes, were comparable between the E group and the T group. After a median follow-up period of 35 months, RFS and OS were similar between the two groups, with the exception of OS for stage II (3-year OS for E group versus T group, 96.9% versus 87.0%; P=.029); however, this difference disappeared after multivariate analyses. Multivariate analyses showed that positive resection margin and higher log carcinoembryonic antigen (CEA) levels were associated with lower RFS. Furthermore, increasing age, positive resection margin, higher log CEA levels, intraoperative surgeon exchange, rectal cancer, postoperative complications, absence of postoperative chemotherapy, and shorter operative time were associated with poor OS.
  
  
  CONCLUSIONS
  Laparoscopic operations undertaken by trainees did not negatively affect short-term outcomes and were not associated with impaired mid-term oncologic outcomes. Our findings support early initiation of training in laparoscopic surgery for colorectal cancer treatment.
authors.affiliation: 1 Department of Surgery, Kyoto Medical Center , Kyoto, Japan .
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ogiso
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Sakai
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Okuchi
authors.forename: Takahide
authors.initials: T
authors.lastname: Murakami
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Hata
authors.forename: Meiki
authors.initials: M
authors.lastname: Fukuda
authors.forename: Iwao
authors.initials: I
authors.lastname: Ikai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D003107:Colorectal Surgery / Q000193:education* / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D061646:Operative Time; D011183:Postoperative Complications / Q000601:surgery*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D016896:Treatment Outcome