title: Long-term oncologic outcomes of laparoscopic right hemicolectomy during the learning curve period: comparative study with cases after the learning curve period.
abstract: BACKGROUND
  This study aimed to assess the learning curve in laparoscopic right hemicolectomy and compare the long-term oncologic outcomes of the learning curve period.
  
  
  METHODS
  We retrospectively reviewed 97 patients who underwent a laparoscopic right hemicolectomy by a single surgeon between July 2006 and January 2009. Among them, 87 patients, excluding patients with stage IV (n=10) disease, were evaluated for long-term oncologic outcomes. They were divided into 2 phases: phase 1 (the learning curve period) and phase 2 (the expert period). The cumulative sum method was used for estimating the learning curve.
  
  
  RESULTS
  The learning curve was determined at the 42nd case. Patient characteristics and postoperative clinicopathologic outcomes were similar in both groups except for the operation time (212.5±65.0 min vs. 146.4±37.1 min; P<0.001) and length of stay (10.7±5.4 d vs. 8.4±2.9 d; P=0.015). The 5-year overall survival rates were similar in both groups throughout all stages. The 5-year disease-free survival rate of stage III disease in phase 2 (85%) was better than that of phase 1 (53.3%; P=0.046).
  
  
  CONCLUSIONS
  Laparoscopic right hemicolectomy during the learning curve period showed acceptable clinicopathologic outcomes. However, the 5-year disease-free survival rate was compromised in patients with stage III disease in phase I.
authors.affiliation: Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Park
authors.forename: Min Sung
authors.initials: MS
authors.lastname: Kim
authors.forename: Gangmi
authors.initials: G
authors.lastname: Kim
authors.forename: Chang Hee
authors.initials: CH
authors.lastname: Kim
authors.forename: Hyuk
authors.initials: H
authors.lastname: Hur
authors.forename: Byung So
authors.initials: BS
authors.lastname: Min
authors.forename: Seung Hyuk
authors.initials: SH
authors.lastname: Baik
authors.forename: Kang Young
authors.initials: KY
authors.lastname: Lee
authors.forename: Nam Kyu
authors.initials: NK
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D002983:Clinical Competence; D003082:Colectomy; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
references.citation: Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350:2050–2059.
references.citation: Veldkamp R, Kuhry E, Hop WC, et al.. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6:477–484.
references.citation: Jayne DG, Guillou PJ, Thorpe H, et al.. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol. 2007;25:3061–3068.
references.citation: Jackson TD, Kaplan GG, Arena G, et al.. Laparoscopic versus open resection for colorectal cancer: a metaanalysis of oncologic outcomes. J Am Coll Surg. 2007;204:439–446.
references.citation: Tekkis PP, Fazio VW, Lavery IC, et al.. Evaluation of the learning curve in ileal pouch-anal anastomosis surgery. Ann Surg. 2005;241:262–268.
references.citation: Wishner JD, Baker JW Jr, Hoffman GC, et al.. Laparoscopic-assisted colectomy. The learning curve. Surg Endosc. 1995;9:1179–1183.
references.citation: Schlachta CM, Mamazza J, Seshadri PA, et al.. Defining a learning curve for laparoscopic colorectal resections. Dis Colon Rectum. 2001;44:217–222.
references.citation: Li JC, Hon SS, Ng SS, et al.. The learning curve for laparoscopic colectomy: experience of a surgical fellow in an university colorectal unit. Surg Endosc. 2009;23:1603–1608.
references.citation: Bokhari MB, Patel CB, Ramos-Valadez DI, et al.. Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc. 2011;25:855–860.
references.citation: Chung Y, Yoon HI, Kim YB, et al.. Radiation pneumonitis in breast cancer patients who received radiotherapy using the partially wide tangent technique after breast conserving surgery. J Breast Cancer. 2012;15:337–343.
references.citation: Yap CH, Colson ME, Watters DA. Cumulative sum techniques for surgeons: a brief review. ANZ J Surg. 2007;77:583–586.
references.citation: Tekkis PP, Smith JJ, Heriot AG, et al.. A national study on lymph node retrieval in resectional surgery for colorectal cancer. Dis Colon Rectum. 2006;49:1673–1683.
references.citation: McDonald JR, Renehan AG, O’Dwyer ST, et al.. Lymph node harvest in colon and rectal cancer: current considerations. World J Gastrointest Surg. 2012;4:9–19.
references.citation: Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc. 1991;1:144–150.
references.citation: Buunen M, Veldkamp R, Hop WC, et al.. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol. 2009;10:44–52.
references.citation: Chen W, Sailhamer E, Berger DL, et al.. Operative time is a poor surrogate for the learning curve in laparoscopic colorectal surgery. Surg Endosc. 2007;21:238–243.
references.citation: Park IJ, Choi GS, Lim KH, et al.. Multidimensional analysis of the learning curve for laparoscopic colorectal surgery: lessons from 1000 cases of laparoscopic colorectal surgery. Surg Endosc. 2009;23:839–846.
references.citation: Park SS, Kim MC, Park MS, et al.. Rapid adaptation of robotic gastrectomy for gastric cancer by experienced laparoscopic surgeons. Surg Endosc. 2012;26:60–67.
references.citation: Buchs NC, Pugin F, Bucher P, et al.. Learning curve for robot-assisted Roux-en-Y gastric bypass. Surg Endosc. 2012;26:1116–1121.
references.citation: Tekkis PP, Senagore AJ, Delaney CP, et al.. Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg. 2005;242:83–91.
references.citation: Son GM, Kim JG, Lee JC, et al.. Multidimensional analysis of the learning curve for laparoscopic rectal cancer surgery. J Laparoendosc Adv Surg Tech A. 2010;20:609–617.
references.citation: Waters JA, Chihara R, Moreno J, et al.. Laparoscopic colectomy: does the learning curve extend beyond colorectal surgery fellowship? JSLS. 2010;14:325–331.
references.citation: Park IJ, Choi GS, Lim KH, et al.. Multidimensional analysis of the learning curve for laparoscopic resection in rectal cancer. J Laparoendosc Adv Surg Tech A. 2009;13:275–281.