Table 4.
Results of individual studies regarding statistical analysis and learning curve
| Author, year | Technique | Learning curve characteristics | Learning curve analysis | Conclusion according to article | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Analysis | Previous experience with surgical technique | Variable (IOC) | Analysis | Variable (POC) | Analysis | CRM rate | Analysis | Operative time | Analysis | Other variable | Analysis | Length | ||
| Balik (2010) [39] | L-TME | Per institute | 305 open + lap CR | – | – | – | – | – | – | Operative time |
SGA: - Sequence: - |
– | – | – |
| Tsai (2015) [40] | L-TME | Per surgeon |
Fellowship completed Little experience in lap |
– | – | – | – | – | – | Operative time | MAA: 22 | – | – | 22 |
| Bege (2010) [11] | L-TME | Per Institute | Not mentioned | – | – | Morbidity | CUSUMD:45 | – | – | – | – | Combination (comb): POC, LR, Conversion, R1 | CUSUMD: 50 | 50 |
| Lujan (2014) [41] | L-TME | Per institute |
Ample experience in open CRR Skilled advanced lap |
– | – | – | – | – | – | Operative time |
Sequence: - SGA: - |
– | – | – |
| Kayano (2011) [58] | L-TME | Per surgeon | Not mentioned | – | Morbidity | SGA: 200 | – | – | Operative time | MAA: 50 | Conversion | SGA: 150 | – | |
| Agha (2008) [42] | L-TME | Per institute |
Experience with lap CR No experience with lap RR |
– | – | SSI | SGA: 20 | – | – | Operative time | SGA: 40 | – | – | – |
| Ito (2009) [59] | L-TME | Per institute | Not mentioned | – | – | Morbidity | SGA: - | – | – | Operative time | SGA: 40 | – | – | – |
| Son (2010) [12] | L-TME | Per surgeon | Not mentioned | Yes | CUSUMD: 243 | Morbidity | CUSUMD: 79 | – | – | Operative time | MAA:61 |
Conversion Transfusion volume |
RA-CUSUMDl: 61 (Conv) SGA:75 (Transfusion volume) |
79 |
| Fukunaga (2008) [26] | L-TME | Per surgeon | Not mentioned | – | – | – | – | – | Operative time | Sequence: - | – | – | – | |
| Kim (2014) [10] | L-TME | Per surgeon |
A: Fast experience B: Trained by A |
– | – | – | – | CRM + |
RA-CUSUMD:50 (A) RA-CUSUMD:70 (B) |
Operative time |
MAAA: 90 MAAB: 90 |
LR |
RA- CUSUMD:110 (A) RA- CUSUMD: 110 (B) |
110 |
| Park (2009) [27] | L-TME | Per surgeon | Not mentioned | – | – | – | – | – | – | Operative time | MAA: 30 |
LR Conversion |
SGA: 69 (LR) CUSUMD: 13 (Conversion) |
69 |
| Kuo (2013) [43] | L-TME | Per institute | Not mentioned | – | – | – | – | – | – | Operative time | SGA: 17 | – | – | 17 |
| Wu (2017) [44] | L-TME | Unclear | Not mentioned | – | – | – | – | – | – | Operative time |
CUSUMD: 36–42 MAA: 36–47 |
– | – | 40 |
| Melich (2015) [45] | R-TME vs L-TME | Per surgeon | 700 open CR, 50 open RR, 150 lap CR | – | – | AL, intra-abdominal abscess | CUSUM: - | CRM + | CUSUM: - | Operative time | MAA: - | – | – | – |
| Morelli (2018) [46] | R-TMESi vs R-TME Xi | Per surgeon |
> 100 RR > 100 lap surgery |
– | – | – | – | – | – | Operative time | CUSUMD: 19 | – | – | 19 |
| Park (2014) [47] | R-TME vs L-TME | Per surgeon | 2 year lap CRR fellowship | – | – | – | – | – | – | Operative time |
CUSUMD: 44 (robot) MAA: 21 (robot) MAA: 69 (lap) CUSUMD: 41 (lap) |
– | – |
44 (robot) 41 (lap) |
| Wang (2021) [51] | R-TME vs L-TME | Per surgeon |
> 300 open CRR > 150 lap CRR Robot training |
– | – | – | – | – | – | Operative time |
CUSUMD: 17 (rob) CUSUMD: 34 (lap) |
– | – |
17 (rob) 34 (lap) |
POC Postoperative complication, IOC Intraoperative complication, RR Rectal resection, CRR Colorectal resection, CR Colon resection, lap Laparoscopy, TAMIS Transanal minimal invasive surgery, CUSUM Cumulative sum analysis, RA-CUSUM Risk-adjusted cumulative sum analysis, CUSUMD Deflection point in CUSUM, CUSUMS Stabilization point in CUSUM, MAA Moving average analysis, MAAS Moving average stabilization point, MAAD Moving average deflection point, SGA Split group analysis, CD Clavien–Dindo classification, CRM Circumferential resection margin, LN Lymph nodes, AL Anastomotic leakage, LR Local recurrence, AL Anastomotic leakage, SSI Surgical site infection, LR Local recurrence, CRT Neoadjuvant chemoradiotherapy, R-TME robot assisted TME, L-TME laparoscopic TME