Quote from Scalpel on 3rd June 2016, 11:59 pm

We are trying a new discussion room for our 2nd journal club.  Please let us know whether you preferred the discussion on the forum or you prefer our new discussion room.  Only registered users can access the discussion.  Login and then click the link above!

Quote from Scalpel on 16th June 2016, 9:12 pm

	19:00Nick Ward Hi everyone, thank you for attending our 2nd journal club, the discussion will begin in a few minutes, for now lets begin with some introductions; i’m Nick a 4th year for Salford
	19:05Daniel Lewis Hi everyone, Daniel here, the chair for the journal club
	19:09Bradley Storey This is the first time trying this new discussion room as in the previous journal club people said that the lack of auto-refresh on the forum was frustrating. Sorry for any technical glitches but will try and resolve any that occur as soon as possible.
	19:10dwang Hi everyone, it’s Derek here. 4th year from Salford.
	19:10Nick Ward Hi Dan and Derek and thanks Bradley, this new chat seems to be workking much better
	19:1052637 James, 4th year, new chat format looks better
	19:11Sarah McBrinn Hi I’m Sarah 3rd year from MRI
	19:12Daniel Lewis I agree the new forum seems to work much better. I guess we may as well start. What were people’s thoughts on the paper?
	19:13Nick Ward I thought the paper was overall good, some limitations on the paper but aimed to address a gap in the knowledge available
	19:14Judith Hi Judith 3rd year Salford
	19:15Judith It was disappointing to see the conclusion reached.
	19:16Sarah McBrinn Nick what do you think the limitations were ? I’ve never reviewed a paper before and am not quite sure what to look at specifically
	19:1752637 I think this paper is a lot more thorough than the last one reviewed
	19:18dwang I thought they used a very good statistical methods of analysing this paper.
	19:18Nick Ward I can understand why it happened but I think it wasn’t ideal that people that opted for the robotic surgery have to pay $6000 extra.. does this create a socio-economic bias?
	19:20Daniel Lewis That’s a good point Nick, if you look at other surgical trials patients are often randomized on entry into the trial. As you say the determinant in this case was whether perople were willing to pay for the robotic treatment.
	19:20Nick Ward I thought the stats methods were good and the use of the clavien-dindo classification was good to classify the complications
	19:21Daniel Lewis Do people think the 5 yr follow up was adequate to comment on long term outcomes?
	19:22dwang Agree Nick. they also used ASA grade to classify co-morbidities prior to the surgery giving a good overview of the medical background for those participants.
	19:22Sarah McBrinn Considering the similarity of the outcomes it would be nice to have some more long term survival data
	19:23Nick Ward i agree sarah, from the results the follow-up data was 4-80 months, why wasn’t the 80 month data displayed?
	19:24Nick Ward and should the 4 month only follow-up have been excluded as this was a study to assess long term outcomes?
	19:25Daniel Lewis On your point Derek, it is good that they discussed ASA grades but they were not used to stratify the patients into different groups. This was donw on willingness to pay. Furthermore if you look in detail at the methods patients were told there may be increased benefit from having the robotic approach, something the study didnt support
	19:29Daniel Lewis Do people think the two procedures were fairly compared?
	19:3052637 They note that there was no significant difference in ASA grades and stratifying on ASA grades might be too much of a reduction in patient groups
	19:30Nick Ward I thought it was controversial that the TNM stages varied so much
	19:31Sarah McBrinn yea I agree nick comparing stages 1-3 is quite a stretch of severities
	19:32dwang Presumably the power of study is good enough, but it would be ideal to have similar number of patients in each group
	19:3852637 This being a single centre study rules out a lot of the possible stratifications that could have been used
	19:39Nick Ward how do you mean?
	19:41Daniel Lewis It being single centre does limit their numbers. It is a pretty common procedure but a limiting factor is the availability of the robotic apparautus.
	19:42Daniel Lewis Which brings me on to asking do you think the results of this study would change anyone’s management?
	19:43Nick Ward I don’t think the results would change my management but I’m not sure if the results would change as robotic skills increase and new techniques are developed?
	19:45Sarah McBrinn Yes I agree the results surprised me as I assumed robotic would be much better than laparoscopic
	19:47Daniel Lewis Looking at other papers in the literature there are reports that show better results with robotic surgery in terms of conversions to open surgery,. length of hospital stay and resectin margin
	19:47Daniel Lewis http://link.springer.com/article/10.1007/s00464-012-2731-4
	19:4852637 If there are benefits of robotic surgery to the surgeon such as reduced risk of accidental injury etc. and advances are being made in robotic surgery then this paper could contribute towards the case for early robotics training
	19:49Nick Ward i agree, thanks for sharing that article dan
	19:49dwang thanks Dan
	19:49Daniel Lewis If you are a practicising surgeon with good experience of robotic techniques and a sense of improved operations and outcomes following robotic procedures I doubt this would change your management. The reeasons being, as you’ve said:
	19:49Daniel Lewis – Its single centre
	19:50Daniel Lewis -not randomized/ and they showed equivalence not worse outcomes
	19:51Daniel Lewis It would have been interesting to have the author’s decision on this as to whether they were going to stop offering the robotic treatment to their patients as a safer more expensive option
	19:52Nick Ward it could be useful to offer the robotic approach in select cases
	19:52Nick Ward e.g. very narrow pelvic cavity
	19:53Daniel Lewis I suspect the answer would probably be no, and that is a huge weakness of this paper in that one treatment arm is financially incentivised.
	19:55Daniel Lewis That’s a good point Nick, and one of the real advantages of robotic surgery is allowing a better view of the pelvic cavity leading to greater surgeon comfort with the anatomy. This is not really assessed by the outcomes in this paper
	19:56Nick Ward As we are approaching an hour, has anyone got any final points to make?
	19:57dwang Can you also judge whether a paper is good or not based on the number of times being cited?
	19:59Nick Ward Thanks to Dan and everyone for joining us tonight; If everyone leaves their emails i’ll ensure you all receive a certificate
	20:01Daniel Lewis Thank you everyone. in answer to your question Derek, it can act as one judging factor. You also need to look at the Journal quality and its impact factor and whether it is being cited in a positive way. It may that its been mentioned in a review or a letter to the editor but the reviewer is actually saying their methods were flawed etc
	20:01dwang Thank you Dan.
	20:02dwang Here is my email address <email> and the name is Haoyu Wang. Thanks Nick.
	20:0352637 Thank you Dan and Nick, interesting read. <email>