Bowel resection performed by gynecologists - Outcomes and learning curves. Activity profile in a Gynecology Department: 7-year observational cohort

Vermel M, Muriel Vermel, Lise Lecointre, Lecointre L, Jochum F, Floriane Jochum, Schwaab T, Thomas Schwaab, Françoise Futcher, Faller É, Émilie Faller, Boisramé T, Thomas Boisramé, Jean‐Jacques Baldauf, Jean-Jacques Baldauf, Baldauf Jj, Chérif Akladios
European journal of obstetrics, gynecology, and reproductive biology · 2021 · vol. 267 , pp. 142–149 · doi:10.1016/j.ejogrb.2021.09.024 · PMID:34773876 · W3204439729
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This observational study examined the outcomes and learning curves of bowel resections performed by gynecologists within a gynecology department over a seven-year period.

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Abstract

ObjectiveBowel resection is frequently used when performing oncological surgery to obtain complete cytoreduction or to remove endometriosis in case of intestinal invasion. Acquiring the surgical skills to perform this kind of procedure is crucial to offer to our patients an optimal management. The aim of this study is to describe a 7-years surgical experience in bowel resections of a gynecologic surgeon and to determine his learning curves.Study designThis is a monocentric retrospective cohort study reporting digestive resection performed between January 2013 and April 2020 in the Gynecology Department of Strasbourg University Hospital. Ninety-one consecutive patients were assigned in two groups: gynecological cancer (n = 44) and deep infiltrating endometriosis (DIE) (n = 47). The main outcome measure was the postoperative complications rate at 30 days, based on the modified Clavien-Dindo severity system. Learning curves were evaluated using cumulative sum (CUSUM) analysis of operative time and risk-adjusted cumulative sum (RA-CUSUM) analysis of severe perioperative complications. Identification of predictive factors for operation duration and severe perioperative complication occurrence was conducted using multivariate analysis.ResultsMinor complications were found in 25% of cases. Major complication rate (Clavien-Dindo ≥ IIIa) was 14% in total and only involved patients operated for cancer. The CUSUM curve for operative time peaked at the 35th case and showed a downward slope after the 45th case. Significant predictive factors of operating time were cytoreductive tumoral surgery, size of the bowel resection and laparoscopic surgery, while learning phase 3 significantly decreased it. The RA-CUSUM curve for severe perioperative complications (Clavien-Dindo ≥ IIIa) showed a progressive decrease in the complication rate as the number of interventions increases without showing clear inflection points. Only cardiopulmonary pathologies were found as significant predictive factor of severe complications.ConclusionProficiency in performing highly complex surgery was achieved after approximately 45 cases, cancer and DIE all together. Acceptable rates of severe perioperative complications were observed even during the initial learning period and are comparable with those found in the literature concerning bowel resection performed by gynecologic oncologists but also by general and digestive surgeons.

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MeSH descriptors

Digestive System Surgical Procedures Gynecology Laparoscopy Female Humans Learning Curve Postoperative Complications Postoperative Complications Postoperative Complications Retrospective Studies

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