Usefulness of participation of endoscopic surgical skill qualification system-qualified surgeons in laparoscopic high anterior resection

Introduction: A technical qualification system was established by the Japanese Society of Endoscopic Surgery in 2004, and its effectiveness in low anterior resection (LAR) has been reported. We herein performed a subgroup analysis of the effectiveness of the participation of technically qualified surgeons in laparoscopy-assisted high anterior resection (HAR), a procedure used for the technical qualification of surgeons. Methods: The EnSSURE study enrolled 3188 patients who underwent laparoscopic rectal resection for rectal cancer between January 2014 and December 2016 at 56 Japanese hospitals. The outcomes of HAR were compared between groups with and without the participation of technically qualified surgeons. The background of the two groups were equalized by propensity score matching. Results: In the group with the participation of qualified surgeons, the operative time was significantly shorter (p =.0427), more lymph nodes were dissected (p =.0207), and the conversion rate to open surgery was lower (p =.0016); however, no significant difference was observed in blood loss (p =.0616), the R0 resection rate (p = 1.00), intraoperative complication rate (p =.160), postoperative complication rate (p = 1.00), or reoperation rate (p =.6999) between the two groups. Furthermore, no significant difference was noted in long-term outcomes (recurrence-free survival (p =.275) or overall survival (p =.941)). Conclusions: In HAR, the technical benefits of the participation of qualified surgeons was limited to a shorter operative time and lower conversion rate. Nevertheless, the qualification is unique in that it predicts the usefulness of reducing complications in more technically challenging procedures when its effectiveness in LAR is considered.