19/02/2021

Association Between Surgical Technical Skill and Long Term Survival for Colon Cancer

Surgical Video Analysis And The Opportunity To Improve

In clinical training, the concept of volume related morbidity, and the variance in skill levels is pretty routinely hammered home. Despite this, sometimes the degree of variance in clinical skill in real life, often impacting very meaningful patient outcomes is still sometimes surprising. It is especially the case as longitudinal outcome measurement in value based healthcare, and more exacting HTA assessment of therapeutics and medical technology slowly become the norm.

I was fascinating therefore to come across this research letter recently in JAMA Oncology, in which Brajcich et al at the Illinois Surgical Quality Improvement Collaborative in Chicago, describe an elegant study looking at 5 year patient survival after laparoscopic colectomy in different surgical skill cohorts.  I am amazed by the apparent size of the skill difference effect (high vs med/low) seen in the main figure, and interested as to how others would interpret this study, and the innovative way they went about assessing quality via surgical video. If this can be replicated by other centres using a similar video assessment technique for laparoscopic resection procedures, the implications for surgical training would seem to be pretty significant.

If replicated, an absolute survival difference of around 20% would qualify moving surgical skill from low/middle to high, as a measurable therapeutic intervention in itself. Many new onco-therapeutic compounds that are approved, fail to reach that level of absolute survival improvement. Presumably any surgical resection procedure which is primarily navigated via on screen vision, or robotic, would be suited for standardised surgical skill assessment.

The speed at which training and skill level acquisition could perhaps be accelerated appears to be very exciting for both clinicians and cancer patients. Original article on this link:  https://jamanetwork.com/journals/jamaoncology/fullarticle/2772313

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