J Gastric Cancer.  2015 Mar;15(1):29-38. 10.5230/jgc.2015.15.1.29.

Lessons Learned from a Comparative Analysis of Surgical Outcomes of and Learning Curves for Laparoscopy-Assisted Distal Gastrectomy

• Moon JS
• Park MS
• Kim JH
• Jang YJ
• Park SS
• Mok YJ
• Kim SJ
• Kim CS
• Park SH

• KMID: 2372368
• DOI: http://doi.org/10.5230/jgc.2015.15.1.29

Abstract

PURPOSE
Before expanding our indications for laparoscopic gastrectomy to advanced gastric cancer and adopting reduced port laparoscopic gastrectomy, we analyzed and audited the outcomes of laparoscopy-assisted distal gastrectomy (LADG) for adenocarcinoma; this was done during the adoptive period at our institution through the comparative analysis of short-term surgical outcomes and learning curves (LCs) of two surgeons with different careers.
MATERIALS AND METHODS
A detailed comparative analysis of the LCs and surgical outcomes was done for the respective first 95 and 111 LADGs performed by two surgeons between July, 2006 and June, 2011. The LCs were fitted by using the non-linear ordinary least squares estimation method.
RESULTS
The postoperative morbidity and mortality rates were 14.6% and 0.0%, respectively, and there was no significant difference in the morbidity rates (12.6% vs. 16.2%, P=0.467). More than 25 lymph nodes were retrieved by each surgeon during LADG procedures. The LCs of both surgeons were distinct. In this study, a stable plateau of the LC was not achieved by both surgeons even after performing 90 LADGs.
CONCLUSIONS
Regardless of the experience with gastrectomy or laparoscopic surgery for other organs, or the age of surgeon, the outcome was quite acceptable; the learning process differ according to the surgeon's experience and individual characteristics.

Keyword

Laparoscopy; Gastrectomy; Learning curve; Treatment outcome

MeSH Terms

Adenocarcinoma
Gastrectomy*
Laparoscopy
Learning
Learning Curve*
Least-Squares Analysis
Lymph Nodes
Mortality
Stomach Neoplasms
Treatment Outcome

Figure

• 

  Fig. 1 Four-phase regression model of the learning curves shown in Equation (2) of Materials and Method section. C1, C2, and C3 are cut-off values dividing the learning curves into four phases; β0 denotes the intercept; β1, β2, β3, and β4 denote the partial changes of slope compared to the previous phases.

• 

  Fig. 2 The phase-wise learning-curve models fitted by non-linear least squares method. The learning curve of the surgeon A had 3 phases (A), while that of the surgeon B had 4 phases (B).

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