关键词: 直肠癌, 肛提肌外腹会阴联合切除术, 累积和控制图, 学习曲线

Abstract:

Analysis of the learning curve for extralevator abdominoperineal excision for low rectal cancer：Lessons from a single center`s experience        GAO Zhi-dong，WANG Chao，SHEN Zhan-long，et al. Department of Gastrointestinal Surgery，Peking University People’s Hospital，Beijing 100044，China
Corresponding author：YE Ying-jiang，E-mail：yeyingjiang@pkuph.edu.cn
Abstract    Objective    To evaluate the learning curve of extralevator abdominoperineal excision (ELAPE) for rectal cancer. Methods    The clinical data of 55 patients with rectal cancer performed ELAPE at Peking University People`s Hospital between June 2012 and October 2014 were analyzed retrospectively. A cumulative sum (CSCUM) analysis was used to derive the learning curve. The differences between the learning phase and the proficient phase in surgical effects were analyzed retrospectively. Results    The cumulative sum analysis revealed the degree of proficiency increased after 30 cases. Compared with learning phase（30 cases），the operative time [（246.6±51.1）min vs.（286.3±43.2）min]，intraoperative blood loss[（146.9±76.0）mL vs.（215.7±162.9）mL]，postoperative dieting time [（6±1）d vs.（7±2）d] in proficient phase (25 cases) decreased significantly respectively (P<0.05). The hospital stay [（19±8）d vs.（18±9）d]，lymph nodes harvest [（17±6）vs.（17±9）]，operation-related complications incidence (24.0% vs. 40.0%)， positive circumferential resection margin (4.0% vs.3.3%)，intraoperative perforation incidence (0 vs. 6.7%) and the quality of specimens had no any statistical significance (P>0.05). Conclusion    The learning process for ELAPE has a greater effect on the first 30 cases.

Key words: rectum cancer, extralevator abdominoperineal excision, cumulative sum chart, learning curve