Document Detail

Systematic review and meta-analysis of trainee- versus expert surgeon-performed colorectal resection.
MedLine Citation:
PMID:  24760684     Owner:  NLM     Status:  Publisher    
BACKGROUND: The aim of this meta-analysis was to compare short-term and oncological outcomes following colorectal resection performed by surgical trainees and expert surgeons.
METHODS: Systematic literature searches were made to identify articles on colorectal resection for benign or malignant disease published until April 2013. The primary outcome was the rate of anastomotic leak. Secondary outcomes were intraoperative variables, postoperative adverse event rates, and early and late oncological outcomes. Odds ratios (ORs), weighted mean differences (WMDs) and hazard ratios (HRs) for outcomes were calculated using meta-analytical techniques.
RESULTS: The final analysis included 19 non-randomized, observational studies of 14 344 colorectal resections, of which 8845 (61·7 per cent) were performed by experts and 5499 (38·3 per cent) by trainees. The overall rate of anastomotic leak was 2·6 per cent. Compared with experts, trainees had a lower leak rate (3·0 versus 2·0 per cent; OR 0·72, P = 0·010), but there was no difference between experts and expert-supervised trainees (3·2 versus 2·5 per cent; OR 0·77, P = 0·080). A subgroup of expert-supervised trainees had a significantly longer operating time for laparoscopic procedures (WMD 10·00 min, P < 0·001), lower 30-day mortality (OR 0·70, P = 0·001) and lower wound infection rate (OR 0·67, P = 0·040) than experts. No difference was observed in laparoscopic conversion, R0 resection or local recurrence rates. For oncological resection, there was no significant difference in cancer-specific survival between trainees and consultants (3 studies, 533 patients; hazard ratio 0·76, P = 0·130).
CONCLUSION: In selected patients, it is appropriate for supervised trainees to perform colorectal resection.
M Kelly; A Bhangu; P Singh; J E F Fitzgerald; P P Tekkis
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-4-23
Journal Detail:
Title:  The British journal of surgery     Volume:  -     ISSN:  1365-2168     ISO Abbreviation:  Br J Surg     Publication Date:  2014 Apr 
Date Detail:
Created Date:  2014-4-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372553     Medline TA:  Br J Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2014 BJS Society Ltd. Published by John Wiley & Sons, Ltd.
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