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Table 6 Surgeons' qualification and control measures for surgical quality within the trials included in the meta-analysis

From: Laparoscopic versus open gastrectomy for locally advanced gastric cancer: a systematic review and meta-analysis of randomized controlled studies

Author year references Surgeons‘ qualification Quality control
Cai 2011 Cai, Wei et al. [19] One single surgeon for the laparoscopic approach
Two other surgeons for the open approach
N/a
Hu 2016 Hu, Huang et al. [22]
Hu, Huang et al. [26]
Surgeons
Have performed at least 50 distal gastrectomies with D2 lymphadenectomy using open and laparoscopic approaches
Were determined to be qualified surgeons by the CLASS academic committee on the basis of the evaluation of unedited videos of both their open and laparoscopic gastrectomy with D2 lymphadenectomy procedures
Institution
At least 300 gastrectomies for patients with AGC annually at each institute
Surgical quality control was maintained by using mandatory intraoperative photographs that identified specific surgical fields, the resection margin of the specimen, and the abdominal incision
Five photos were required to verify the surgical quality of the D2 lymph node clearance as
follows:
(1) The area between the pancreatic tail and the lower pole of the spleen
(2) The pancreatic head and infrapyloric area
(3) The right side of the suprapancreatic area
(4) The left side of the suprapancreatic area
(5) The lesser curvature area
These photos were reviewed, and feedback on the assessment was regularly provided to the investigators
Park 2018 Park, Yoon et al. [31]
Kim, Park et al. [27]
Kim, Park et al. [20]
Nam, Kim et al. [21]
Surgeons
Had performed at least 30 LADG procedures before the start of this study
To standardize the open and laparoscopic D2 lymphadenectomy procedures, all surgeons attended 10 video seminars to observe unedited videos of the surgical procedure before the start of this trial. To evaluate the D2 lymphadenectomies, we created a list of checkpoints to determine their success.
Shi 2018 Shi, Xu et al. 2017 Surgeons
Had performed either LAG or OG with D2 lymphadenectomy in more than 50 cases
Before the trial, all participating surgeons reviewed and agreed to the technical details for the surgical procedures
Institution
Center with significant experience in gastric cancer surgery
Surgical quality control was maintained by regular reviews of the recorded videos of LAGs and the photographs of OGs
Results of the assessments were provided to each surgeon
Wang 2018 Wang, Xing et al. 2018 Surgeons
Specialized in gastric surgery
Have already conducted at least 60 ODG and 60 LADG with D2 lymphadenectomy previously
Institutions
At least 80 gastrectomies/institution for advanced gastric cancer patients each year
Intraoperative photographs and unedited videos were mandatory required and monitored by the study chair to control the surgical quality
Ten photos were uploaded for each participant. Among them, five pictures were taken for lymph node dissection fields, four for the lesion and resection margins of specimens, and one for the abdominal incision