The Impact of Surgical Training on Clinical Outcomes After Oesophagectomy: A Systematic Review and Meta Analysis

Abstract Aim Surgical training, including in technical skills through theatre exposure, is integral to healthcare delivery and sustainability. We sought to investigate the impact of intraoperative trainee involvement during oesophageal resection on perioperative outcomes. Method A protocol was registered at PROSPERO (CRD42022330705). Seven databases were searched up to May 2022. Studies providing direct comparison between consultant- and trainee-performed oesophagectomies in adult patients were included. The co-primary outcomes were length of hospital stay and 30-day survival. Data was analysed in Stata SE v17. Log odds ratios (log OR) were calculated for dichotomous outcomes, whilst continuous variables were summarised as mean differences (MD). A random-effects model was employed. Heterogeneity was assessed using I2. Bias was assessed using ROBINS-I. Results 804 studies were screened, with 9 papers considered in the final quantitative synthesis. 3183 (72% male) patients, including 762 (24%) trainee-led cases, were included. There was a high risk of bias across included papers. Hospital stay was significantly shorter in the trainee group (MD -1.83 days: 95% CI [-2.88, -0.78], p<0.01). There was no difference in 30-day survival (p = 0.23), in-hospital survival (p = 0.92), anastomotic leak (p = 0.80), operative time (p = 0.63) or completeness of resection (p = 0.76) between groups. Conclusions Trainee involvement in oesophageal resections does not appear to have a detrimental impact on patient safety and outcomes. High-quality studies, with consistent outcome reporting and larger populations are needed to further inform this area of interest.