Transoral Laser Surgery: The Learning Curve

Abstract

Objective

To assess the learning curve in transoral laser surgery for malignant tumors of the larynx and hypopharynx.

Methods

Prospective data collection in a SPSS data base from 1998 to 2004. Inclusion criteria: Patients with untreated malignant tumors of the aerodigestive tract treated with curative intent. Patients were divided into consecutive subgroups of n= 50 depending on the experience of the surgeons. Outcome assessment was prformed specifically for number of surgeries per patient, complications, recurrence rates and adjusted survival.

Results

680 patients met the inclusion criteria. Up to 4 groups of increasing consecutive experience could be formed. The number of operations per patients (1,87 operation for group #1 compared to 1.36 for group #4) and the complication rates were significantly reduced with increased experience. Complication rates were linked with a statistical significance to larger tumors (p< 0.0001). Free tumor margins were not related to experience (p=0.307), neither the recurrence rates (the lowest Chi-square achieved a p=0.088 for the first group of 50 compared to the fourth group of 50). Adjusted survival rates showed a trend of improvement with larger experience when studied individually, but no significant statistical difference was observed (p >0.05).

Conclusions

Assessing surgical experience for new technologies is not as simple, as new joining surgeons profit from experienced colleagues. The complication rate clearly seems to depend on experience; however, patient adjusted survival rates do not.