J Gastric Cancer.  2010 Dec;10(4):247-253.

Comparison of Learning Curves and Clinical Outcomes between Laparoscopy-assisted Distal Gastrectomy and Open Distal Gastrectomy

• Kang SY
• Lee SY
• Kim CY
• Yang DH

Abstract

PURPOSE
Most stomach surgeons have been educated sufficiently in conventional open distal gastrectomy (ODG) but insufficiently in laparoscopy-assisted distal gastrectomy (LADG). We compared learning curves and clinical outcomes between ODG and LADG by a single surgeon who had sufficient education of ODG and insufficient education of LADG.
MATERIALS AND METHODS
ODG (90 patients, January through September, 2004) and LADG groups (90 patients, June 2006 to June 2007) were compared. The learning curve was assessed with the mean number of retrieved lymph nodes, operation time, and postoperative morbidity/mortality.
RESULTS
Mean operation time was 168.3 minutes for ODG and 183.6 minutes for LADG. The mean number of retrieved lymph nodes was 37.9. Up to about the 20th to 25th cases, the slope decrease in the learning curve for LADG was more apparent than for ODG, although they both reached plateaus after the 50th cases. The mean number of retrieved lymph nodes reached the overall mean after the 30th and 40th cases for ODG and LADG, respectively. For ODG, complications were evenly distributed throughout the subgroups, whereas for LADG, complications occurred in 10 (33.3%) of the first 30 cases.
CONCLUSIONS
Compared with conventional ODG, LADG is feasible, in particular for a surgeon who has had much experience with conventional ODG, although LADG required more operative time, slightly more time to get adequately retrieved lymph nodes and more complications. However, there were more minor problems in the first 30 LADG than ODG cases. The unfavorable results for LADG can be overcome easily through an adequate training program for LADG.

Keyword

Laparoscopic; Gastrectomy; Learning curve

MeSH Terms

Gastrectomy
Humans
Learning
Learning Curve
Lymph Nodes
Operative Time
Stomach

Figure

• 

  Fig. 1 Operative time is displayed as a scatterplot and plotted a best fit line using the Loess fit method. The weight function used in the Loess method is the tricube weight function. The line shows the learning curve. (A) For ODG, the operation time decreased slightly after the second 10 ODGs and reached its plateau after the fifth 10 ODGs. (B) For LADG, the operation time decreased abruptly up to the second 10 LADGs and reached its plateau after the fifth 10 LADGs. ODG = open distal gastrectomy; LADG = laparoscopy-assisted distal gastrectomy.

• 

  Fig. 2 Overall, the mean number of retrieved lymph nodes (mean±SD) was 37.9 (±15.6) in the ODG group and 37.8 (±20.7) in the LADG group. The mean number of retrieved lymph nodes in the sequential subgroups of 10 procedures reached the overall mean after the third 10 procedures for ODG and after the fourth 10 procedures for LADG. CI = confidence interval; ODG = open distal gastrectomy; LADG = laparoscopy-assisted distal gastrectomy.

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