• George B Hanna, Hugh Mackenzie, Danilo Miskovic, Melody Ni, Susannah Wyles, Paul Aylin, Amjad Parvaiz, Tom Cecil, Andrew Gudgeon, John Griffith, Jonathan M Robinson, Chelliah Selvasekar, Tim Rockall, Austin Acheson, Charles Maxwell-Armstrong, John T Jenkins, Alan Horgan, Chris Cunningham, Ian Lindsey, Tan Arulampalam, Roger W Motson, Nader K Francis, Robin H Kennedy, Mark G Coleman, and on behalfofLapco program.
• Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
• Ann. Surg. 2022 Jun 1; 275 (6): 114911551149-1155.

ObjectiveTo examine the impact of The National Training Program for Lapco on the rate of laparoscopic surgery and clinical outcomes of cases performed by Lapco surgeons after completion of training.Summary Of Background DataLapco provided competency-based supervised clinical training for specialist colorectal surgeons in England.MethodsWe compared the rate of laparoscopic surgery, mortality, and morbidity for colorectal cancer resections by Lapco delegates and non-Lapco surgeons in 3-year periods preceding and following Lapco using difference in differences analysis. The changes in the rate of post-Lapco laparoscopic surgery with the Lapco sign-off competency assessment and in-training global assessment scores were examined using risk-adjusted cumulative sum to determine their predictive clinical validity with predefined competent scores of 3 and 5 respectively.ResultsOne hundred eight Lapco delegates performed 4586 elective colo-rectal resections pre-Lapco and 5115 post-Lapco while non-Lapco surgeons performed 72,930 matched cases. Lapco delegates had a 37.8% increase in laparoscopic surgery which was greater than non-Lapco surgeons by 20.9% [95% confidence interval (CI), 18.5-23.3, P < 0.001) with a relative decrease in 30-day mortality by -1.6% (95% CI, -3.4 to -0.2, P = 0.039) and 90-day mortality by -2.3% (95% CI, -4.3 to -0.4, P = 0.018). The change point of risk-adjusted cumulative sum was 3.12 for competency assessment tool and 4.74 for global assessment score whereas laparoscopic rate increased from 44% to 66% and 40% to 56%, respectively.ConclusionsLapco increased the rate of laparoscopic colorectal cancer surgery and reduced mortality and morbidity in England. In-training competency assessment tools predicted clinical performance after training.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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