Learning curve for the management of locally advancedprimary and recurrent rectal cancer: a single team's experience: LTP24

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Aim:To define the learning curve required to improve the peri-operative outcomes of patients operated for recurrent and locally advancedprimary rectal cancer.Method:Consecutive patients undergoing exenterative surgery for colorectal pelvic cancer, by one surgical team, between 2006 and 2009, were included. The patients were divided into quartiles (Q1-Q4) according to the date of surgery. Peri-operative outcomes wereprospectively assessed. A risk-adjusted Cumulative Sum (CUSUM) model was used to evaluate the learning curve.Results:Forty-four patients (29 males; median age 61 (29-78); 11primary cancers) were included in the study. Fifteen patients underwent abdominosacral resection and 26 other pelvic exenterative operations. Pelvic and/or perineal plastic reconstructionprocedures (n = 17) increased significantly from two patients in Q1 to 7 in Q4 (P = 0.058). Consequently, intraoperative time remained unchanged (P = 0.774). The median intra-operative blood loss was reduced from 1.5 (Q1) to 0.6 (Q4) liters (P = 0.548). Complete resection (R0) was achieved in 30 patients. Median hospital stay declined from 22 (Q1) to 15 (Q4) days (P = 0.008). Major complications (re-operations) were significantly reduced from six in Q1 to one in Q4 (p = 0.011). Risk-adjusted CUSUM analysis demonstrated an improvement in the major complications after 15 operations.Conclusion:Fifteen cases are required to gain the desirable training and experience to enhance perioperative outcomes.

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