title: Learning curve and long-term outcomes of laparoscopy-assisted distal gastrectomy for gastric cancer.
abstract: OBJECTIVE
  To discuss the learning curve of laparoscopy-assisted distal gastrectomy (LADG) with lymph node dissection and the oncological results and long-term outcomes of different periods in the learning stage.
  
  
  METHODS
  One hundred twenty-four patients with gastric cancer who received LADG with lymph node dissection from January 2004 to December 2009 were retrospectively reviewed and analyzed. They were divided into three groups (A-C) according to different operative date: 41 were in Group A (early), 41 in Group B (middle), and 42 in Group C (laer). There were no significant statistical differences among the three groups with respect to age, gender, early/advanced gastric cancer, Union for International Cancer Control stage, and lymph node dissection. Then the following items were compared in these groups: operative time, blood loss, number of lymph nodes harvested, postoperative complications, postoperative hospital stay, and long-term survival.
  
  
  RESULTS
  The operative time in Group A (235.0±50.3 minutes) was significantly longer than in Groups B (201.7±39.6 minutes) and C (199.0±44.7 minutes), but there was no significant difference between Groups B and C. The harvest of lymph nodes from Group A (11.0±5.5) was significantly less than from Groups B (16.3±9.2) and C (17.2±8.7), but there was no significant difference between Groups B and C. The postoperative hospital stay and complications, overall survival, and disease-free survival showed no difference among the three groups.
  
  
  CONCLUSIONS
  The learning curve of gastrointestinal surgeons with experience of laparoscopic operation is about 40 cases. The oncological principles and long-term outcomes were not sacrificed during the learning stage.
authors.affiliation: Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai, China; Shanghai Minimally Invasive Surgery Center , Shanghai, China .
authors.forename: Wei-guo
authors.initials: WG
authors.lastname: Hu
authors.forename: Jun-Jun
authors.initials: JJ
authors.lastname: Ma
authors.forename: Lu
authors.initials: L
authors.lastname: Zang
authors.forename: Pei
authors.initials: P
authors.lastname: Xue
authors.forename: Hua
authors.initials: H
authors.lastname: Xu
authors.forename: Ming-Liang
authors.initials: ML
authors.lastname: Wang
authors.forename: Ai-Guo
authors.initials: AG
authors.lastname: Lu
authors.forename: Jian-Wen
authors.initials: JW
authors.lastname: Li
authors.forename: Bo
authors.initials: B
authors.lastname: Feng
authors.forename: Min-Hua
authors.initials: MH
authors.lastname: Zheng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy / Q000193:education* / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000379:methods; D059032:Learning Curve; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome