Learning curve for laparoscopy-assisted distal gastrectomy with regional lymph node dissection for early gastric cancer.
An assessment of the learning curve of laparoscopy-assisted distal gastrectomy (LADG) might encourage its worldwide spread among inexperienced surgeons. One hundred sixty-seven patients with early gastric cancer were enrolled in this study: 67 underwent conventional open distal gastrectomy and 100 underwent LADG after classification into 5 groups of 20 according to the surgeon's level of experience. Patient characteristics and operative findings were compared between groups. Operation time was significantly longer, time to first flatus earlier, and blood loss reduced in the LADG groups compared with the open distal gastrectomy group. Surgeons with experience of 60 cases performed operations of similar times in both groups, and blood loss decreased with experience of 20 cases. There was no operative conversion, the frequency of nonsteroidal anti-inflammatory drugs administered were significantly less, and length of hospital stay were shorter by surgeons with experience of 60 cases. LADG is a technically feasible surgical procedure, depending on the surgeon's technical proficiency. Experience of at least 60 cases of LADG seems to result in satisfactory patient outcomes.
Department of Surgery, Gastroenterological Center, Yokohama City University, Urafunecho, Minami-ku, Yokohama, Japan. s0714@med.yokohama-cu.ac.jp
Chikara
C
Kunisaki
Hirochika
H
Makino
Naoto
N
Yamamoto
Tsutomu
T
Sato
Takashi
T
Oshima
Yasuhiko
Y
Nagano
Syoichi
S
Fujii
Hirotoshi
H
Akiyama
Yuichi
Y
Otsuka
Hidetaka A
HA
Ono
Takashi
T
Kosaka
Ryo
R
Takagawa
Hiroshi
H
Shimada
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004522:Educational Status; D005260:Female; D005743:Gastrectomy / Q000193:education* / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome