The learning curve associated with laparoscopic total gastrectomy

Background Although the frequency of laparoscopic total gastrectomy (LTG) has been increasing, the procedure requires considerable experience because of its technical difficulty and the concern for oncological safety. This study intended to define the learning curve associated with the procedure. Me...

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Bibliographic Details
Published in:Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 2016-01, Vol.19 (1), p.264-272
Main Authors: Jung, Do Hyun, Son, Sang-Yong, Park, Young Suk, Shin, Dong Joon, Ahn, Hye Seong, Ahn, Sang-Hoon, Park, Do Joong, Kim, Hyung-Ho
Format: Article
Language:English
Subjects:
Abdominal Surgery
Adult
Aged
Aged, 80 and over
Blood Loss, Surgical
Cancer Research
Clinical Competence
Female
Gastrectomy - education
Gastrectomy - methods
Gastric cancer
Gastroenterology
Humans
Laparoscopy - education
Laparoscopy - methods
Learning Curve
Length of Stay
Lymph Nodes - surgery
Male
Medicine
Medicine & Public Health
Middle Aged
Oncology
Operative Time
Original Article
Spleen - surgery
Surgical Oncology
Young Adult
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Summary:Background Although the frequency of laparoscopic total gastrectomy (LTG) has been increasing, the procedure requires considerable experience because of its technical difficulty and the concern for oncological safety. This study intended to define the learning curve associated with the procedure. Methods All 256 cases of LTG performed from June 2003 to December 2012 were enrolled. The cases were divided into ten groups of 25 cases based on when they occurred. The learning curve was defined using the moving average method. LTG, performed in the absence of other procedures (pure-LTG, 132 cases), was extracted from the ten groups, and the mean operative time and estimated blood loss (EBL) were compared to define the learning curve. Retrieved lymph nodes, hospital stay, and complications were compared across the phases of the learning curve. LTG with spleen resection, performed in the absence of other procedures (pure-srLTG, 53 cases), was also analyzed by the same method. Results A three-phase learning curve of LTG was defined: the first two groups, the following two groups, and the final six groups (mean operative time: 223.0, 244.8, and 207.8 min, respectively, p  = 0.003; mean EBL: 94.6, 237.0, and 116.5 ml, respectively, p  
ISSN:1436-3291
1436-3305
DOI:10.1007/s10120-014-0447-y