title: Learning curves of minimally invasive esophageal cancer surgery.
abstract: 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.
authors.affiliation: Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeollanamdo, South Korea.
authors.forename: Sang Yun
authors.initials: SY
authors.lastname: Song
authors.forename: Kook Joo
authors.initials: KJ
authors.lastname: Na
authors.forename: Sang Gi
authors.initials: SG
authors.lastname: Oh
authors.forename: Byoung Hee
authors.initials: BH
authors.lastname: Ahn
mesh_terms: 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