Learning curve for total gastrectomy with D2 lymph node dissection: cumulative sum analysis for qualified surgery

This study was conducted to evaluate the leaning curve of D2 lymph node dissection for patients with gastric cancer in a high-volume center. The authors prospectively reviewed the data of all patients who underwent total gastrectomy with D2 lymph node dissection during a 4-year period. Retrieved lym...

Full description

Saved in:
Bibliographic Details
Published in:Annals of surgical oncology 2006-09, Vol.13 (9), p.1175-1181
Main Authors: Lee, Jun Ho, Ryu, Keun Won, Lee, Jin-Hee, Park, Sook Ryun, Kim, Chan Gyoo, Kook, Myoung Cheorl, Nam, Byung-Ho, Kim, Young-Woo, Bae, Jae-Moon
Format: Article
Language:English
Subjects:
Adenocarcinoma - surgery
Adult
Aged
Aged, 80 and over
Clinical Competence
Female
Gastrectomy
General Surgery - education
Humans
Lymph Node Excision
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Staging
Physician's Role
Prognosis
Prospective Studies
Stomach Neoplasms - surgery
Survival Rate
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:This study was conducted to evaluate the leaning curve of D2 lymph node dissection for patients with gastric cancer in a high-volume center. The authors prospectively reviewed the data of all patients who underwent total gastrectomy with D2 lymph node dissection during a 4-year period. Retrieved lymph node number was used as a surrogate marker of oncological outcome. The retrieved lymph node number cut-off value required for satisfactory D2 lymph node dissection was defined as >25. Cumulative sum analysis was used to examine the learning curves of individual surgeons at target accuracy rates of 85%, 90%, 92.5%, 95%, and 98%. Two junior staff surgeons performed 198 curative-intent total gastrectomies with D2 lymph node dissections during the study period; their success rates exceeded 90%. Operating time decreased with operative experience (Pearson correlation coefficient = -0.515, P < 0.001). The learning period for total gastrectomy with D2 lymph node dissection for these two junior members of staff was calculated as 23-35 cases, presuming a 92.5% success rate. The current study suggests that the surgical learning period for D2 lymph node dissection extends to at least 23 cases or 8 months. In clinical trials containing gastric cancer surgery, the learning curve for qualified surgery from the standpoint of oncological outcome should be considered to minimize bias due to surgeon-associated factors.
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-006-9050-8