Safety and feasibility of laparoscopic surgery for colorectal and gastric cancer under the Chinese multi-site practice policy:admittance standards of competence are needed  

作　　者：Zhenghao Cai Haiqin Song Zhenfeng Huang Abraham Fingerhut Ximo Xu Hao Zhong Zhigang Li Yingjie Zhang Dachong Sha Dandan Bao Haibo Wang Binghua Cai Shangbo Hua Yanhui Zhang Jianguang Sun Ke Ye Jianwen Li Yong Lu Bo Feng 

机构地区：[1]Department of General Surgery,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,P.R.China [2]Shanghai Minimally Invasive Surgery Center,Shanghai,P.R.China [3]Department of General Surgery,People’s Hospital of Rui’an,Zhejiang,P.R.China [4]Section for Surgical Research,Department of Surgery,Medical University of Graz,Graz,Austria [5]Department of General Surgery,Wuxi Huishan District People’s Hospital,Jiangsu,P.R.China [6]Department of General Surgery,Zhoushan Hospital,Zhejiang,P.R.China [7]Department of General Surgery,Cixi Third People’s Hospital,Zhejiang,P.R.China [8]Department of General Surgery,People’s Hospital of Wenzhou,Zhejiang,P.R.China [9]Department of General Surgery,Chinese PLA 107 Hospital,Shandong,P.R.China [10]Department of General Surgery,Rudong People’s Hospital,Jiangsu,P.R.China [11]Department of General Surgery,Kunshan Hospital of Chinese Medicine,Jiangsu,P.R.China [12]Department of General Surgery,Jingjiang Chinese Medicine Hospital,Jiangsu,P.R.China [13]Department of General Surgery,Haiyan People’s Hospital,Zhejiang,P.R.China [14]Department of General Surgery,Yueqing People’s Hospital,Zhejiang,P.R.China [15]Department of Medical Affairs,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,P.R.China

出　　处：《Gastroenterology Report》2022年第1期490-497,共8页胃肠病学报道（英文）

基　　金：funded by the National Facility for Translational Medicine(Shanghai,China)[grant number TMSK-2021–503 to B.F.].

摘　　要：Background:The multi-site practice(MSP)policy has been practiced in China over 10 years.This study aimed to investigate the safety and feasibility of performing laparoscopic surgery for colorectal cancer(LSCRC)and gastric cancer(LSGC)under the Chinese MSP policy.Methods:We collected and analysed the data from 1,081 patients who underwent LSCRC or LSGC performed by one gastrointestinal surgeon in his original hospital(n=573)and his MSP institutions(n=508)between January 2017 and December 2020.Baseline demographics,intraoperative outcomes,post-operative recovery,and pathological results were compared between the original hospital and MSP institutions,as well as between MSP institutions with and without specific competence(surgical skill,operative instrument,perioperative multi-discipline team).Results:In our study,690 patients underwent LSCRC and 391 patients underwent LSGC.The prevalence of post-operative complications was comparable for LSCRC(11.5%vs 11.1%,P=0.89)or LSGC(15.2%vs 12.6%,P=0.46)between the original hospital and MSP institutions.However,patients in MSP institutions without qualified surgical assistant(s)and adequate instruments experienced longer operative time and greater intraoperative blood loss.The proportion of patients with inadequate lymph-node yield was significantly higher in MSP institutions than in the original hospital for both LSCRC(11.5%vs 21.2%,P<0.01)and LSGC(9.8%vs 20.5%,P<0.01).Conclusion:For an experienced gastrointestinal surgeon,performing LSCRC and LSGC outside his original hospital under the MSP policy is safe and feasible,but relies on the precondition that the MSP institutions are equipped with qualified surgical skills,adequate operative instruments,and complete perioperative management.

关 键 词：health policy gastrointestinal tumors laparoscopic surgery public health quality in health care 

分 类 号：R735[医药卫生—肿瘤]