J Gastric Cancer.  2017 Sep;17(3):237-245. 10.5230/jgc.2017.17.e30.

Laparoscopic Gastrectomy Performed by an Expert in Open Gastrectomy

• Chi KC
• Park JM

• KMID: 2389828
• DOI: http://doi.org/10.5230/jgc.2017.17.e30

Abstract

PURPOSE
Senior surgeons prefer open gastrectomy (OG), while young surgeons prefer laparoscopic gastrectomy (LG). The purpose of this study was to evaluate the surgical outcomes of LG performed by a senior surgeon who was an expert in OG during his learning period, by comparing them with LGs performed by a young surgeon.
MATERIALS AND METHODS
A senior surgeon performed 50 curative gastrectomies with laparoscopy (LG-S group) from March 2015 to August 2016. A young surgeon's initial 50 LGs comprised the LG-Y group. Clinicopathological characteristics and surgical outcomes were compared between the LG-S and LG-Y groups.
RESULTS
D2 lymphadenectomy was more frequently performed in the LG-S group than in the LG-Y group (P=0.029). The operation time and number of retrieved lymph nodes did not significantly differ between the 2 surgeons (P=0.258 and P=0.410, respectively). Postoperative hospital stay and postoperative complication rate were similar between 2 groups (P=0.234 and P=1.000, respectively). Similarly, significant decreases in operation time with increasing case numbers were observed for both surgeons, whereas the number of retrieved lymph nodes increased significantly in the LG-Y group but not in the LG-S group.
CONCLUSIONS
The LG outcomes when performed by the senior surgeon were comparable to those when performed by the young surgeon, despite performing more extended lymphadenectomies. Senior surgeons who are experts in OG should not refrain from performing LG.

Keyword

Gastrectomy; Laparoscopy; Learning curve; Stomach neoplasms

MeSH Terms

Gastrectomy*
Laparoscopy
Learning
Learning Curve
Length of Stay
Lymph Node Excision
Lymph Nodes
Postoperative Complications
Stomach Neoplasms
Surgeons

Figure

• 

  Fig. 1 Operation time is displayed as a scatter plot according to the consecutive case numbers of patients who underwent LG performed by the senior surgeon (A) and the young surgeon (B). Operation time decreased significantly with increasing case number for both the senior surgeon (r2=0.213, P=0.001) and the young surgeon (r2=0.148, P=0.006). LG = laparoscopic gastrectomy; LG-S = laparoscopic gastrectomy by the senior surgeon; LG-Y = laparoscopic gastrectomy by the young surgeon.

• 

  Fig. 2 The number of retrieved lymph nodes is displayed as a scatter plot according to the consecutive case numbers of patients who underwent LG performed by the senior surgeon (A) and the young surgeon (B). The number of retrieved lymph nodes increased significantly with increasing case number for the young surgeon (r2=0.183, P=0.002), whereas there was no significant increase in the number of retrieved lymph nodes for the senior surgeon (r2=0.052, P=0.111). LG = laparoscopic gastrectomy; LG-S = laparoscopic gastrectomy by the senior surgeon; LG-Y = laparoscopic gastrectomy by the young surgeon.

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