• Annals of surgery · Nov 2023

    Review

    Predictive Value of KLASS-02-QC Assessment Score on KLASS-02 surgical Outcomes: Validation of Surgeon Quality Control and Standardization for D2 Lymphadenectomy.

    • Jeong Ho Song, Hye Jung Shin, Woo Jin Hyung, Han-Kwang Yang, Sang-Uk Han, Young-Kyu Park, Hyuk-Joon Lee, Ji Yeong An, Wook Kim, Hyung-Ho Kim, Seung Wan Ryu, Hoon Hur, Min-Chan Kim, Seong-Ho Kong, Jin-Jo Kim, ParkDo JoongDJDepartment of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea., Young Woo Kim, Keun Won Ryu, KimJong WonJWDepartment of Surgery, Chung-Ang University Hospital, Seoul, South Korea., Joo-Ho Lee, and Hyoung-Il Kim.
    • Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
    • Ann. Surg. 2023 Nov 1; 278 (5): e1011e1017e1011-e1017.

    ObjectiveThe aim of this study was to audit the 22 items and assessed each item's predictive value on surgical outcomes.BackgroundThe KLASS-02 trial revealed that the oncologic outcomes of laparoscopic distal gastrectomy are not inferior to open distal gastrectomy in patients with advanced gastric cancer. The surgeons participating in this trial were chosen based on the assessment scores from the KLASS-02-QC trial, which used 22 items for standardization of D2 lymphadenectomy and quality control.MethodsWe reviewed proficiency scores (PSs) for 22 items for 20 surgeons who participated in KLASS-02. The surgeons were divided into 2 groups according to PS, and the perioperative outcomes of 924 patients enrolled in KLASS-02 were compared between groups. Each item's predictive value for perioperative outcome was then assessed using multivariable regression models.ResultsOf the total 924 patients, 529 were operated on by high-score surgeons (high PS) and 395 were operated on by low-score surgeons (low-PS). High-PS group had less intraoperative blood loss, longer operation times, and fewer complications, major complications, reoperations, and shorter first flatus and hospital stay than low-PS group ( P =0.006, P <0.001, P <0.001, P <0.001, P =0.042, P =0.013, and P <0.001, respectively). Some items used in KLASS-02-QC predicted perioperative outcomes, such as intraoperative blood loss, major complications, reoperation, and hospital stay.ConclusionsAlthough this study only analyzed data associated with qualified surgeons, the 22 items effectively assessed the surgeons based on PS. A high score was associated with longer operation times, but better perioperative outcomes.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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