Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer.
BACKGROUND
Laparoscopy-assisted gastrectomy (LAG) is a complex and time-consuming procedure, which is increasingly used for early gastric cancer (EGC). We provide a multidimensional analysis of the learning curve in LAG.


METHODS
Cumulative sum method was used to analyze outcomes of 109 patients undergoing LAG for EGC by one surgeon over a two year period; the influence of patient selection was evaluated. Target failure rate was set at 10%, with failure defined as open conversion, mortality, major morbidity, residual tumor, or inappropriate lymphadenectomy.


RESULTS
There were 19 failures--fourteen performance and five oncologic. The learning curve, which displayed a slight rising trend and three phases was achieved after 40 cases with selected patients; it was broken, however, by the introduction of advanced procedures and unselected patients.


CONCLUSIONS
Advanced procedures and broad indications in LAG should be delayed until a learning curve is completed under the target failure rate.
Jin
Sung-Ho
SH
Department of Surgery, School of Medicine, Ajou University, San-5, Wonchon-Dong, Yeongtong-Gu, Suwon, 442-749, Korea.
Kim
Do-Yoon
DY
Kim
Hong
H
Jeong
In Ho
IH
Kim
Myung-Wook
MW
Cho
Yong Kwan
YK
Han
Sang-Uk
SU
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000193:education* / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007858:Learning; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D017211:Treatment Failure; D016896:Treatment Outcome; D019564:Unnecessary Procedures