Learning curves of minimally invasive esophageal cancer surgery.
BACKGROUND
Minimally invasive esophageal cancer surgery (MIES) has been performed at some experienced health centers. MIES has shown to be feasible and safe in esophageal cancer surgery. However, there are a few reports concerning the learning curve of MIES.


METHODS
From 2004 to 2007, MIES was performed in 28 patients by a single surgeon. This amount includes total MIES that contained thoracoscopic esophagectomy, laparoscopic gastric preparation, cervical anastomosis and hybrid MIES that contained only one scope surgery. Surgical outcomes and clinical factors in the first 14 patients (group A) and the other 14 patients (group B) were compared.


RESULTS
There were no differences in clinical factors between the two groups. Total MIES was completed in 14 patients, while 13 patients underwent hybrid MIES. There were 6 cases of emergent conversion to open procedures; one case was a thoracotomy and 5 cases were a laparotomy. Chest, abdominal, and total operation time were shorter in group B (p<0.05). The amount of red cell transfusions and intensive care unit stay times were less in the total MIES group (p<0.05). There was one hospital mortality due to acute respiratory distress syndrome. Postoperative complication rate was 43%.


CONCLUSIONS
As cases increase, surgical outcomes have improved. We think that this report showed a substantial learning curve for a complex surgery such as MIES.
Song
Sang Yun
SY
Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeollanamdo, South Korea.
Na
Kook Joo
KJ
Oh
Sang Gi
SG
Ahn
Byoung Hee
BH
D000328:Adult; D000368:Aged; D002983:Clinical Competence; D004502:Education, Medical, Continuing; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000193:education* / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000592:standards; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000193:education / Q000379:methods / Q000592:standards; D011183:Postoperative Complications; D056910:Republic of Korea; D013906:Thoracoscopy / Q000009:adverse effects / Q000592:standards; D016896:Treatment Outcome