Does the Endoscopic Surgical Skill Qualification System improve patients’ outcome following laparoscopic surgery for colon cancer? A multicentre, retrospective analysis with propensity score matching.

Purpose: This study aimed to investigate the short-term and oncological impact of the Endoscopic Surgical Skill Qualification System (ESSQS) by the Japan Society for Endoscopic Surgery on the operator performing laparoscopic surgery for colon cancer. Methods: This retrospective cohort study was based on medical records from a multicentre database. A total of 417 patients diagnosed with stage II/III colon and rectosigmoid cancer treated with curative resection were divided into two groups according to whether they were operated on by qualified surgeons (Q group, n=352) or not (NQ group, n=65). Through strict propensity score matching, 98 cases (49 in each group) were assessed. Results: Operative time was significantly longer in the NQ group than in the Q group (199 vs. 168 min, p=0.029). The amount of blood loss, postoperative complications, and duration of hospitalisation were similar between both groups. No mortality was observed. One conversion case was seen in the NQ group. The 3-year recurrence-free survival rate was 86.6% in the NQ group and 88.2% in the Q group, which was not statistically significant (log-rank p=0.966). Conclusion: Direct operation by ESSQS-qualified surgeons contributed to a shortened operation time. Under an organized educational environment, almost equivalent safety and oncological outcomes are expected regardless of the surgeon’s qualifications.