title: Learning curve of laparoscopic low anterior resection in terms of local recurrence.
abstract: BACKGROUND
  Experience in terms of surgical case numbers required to develop proficiency for oncologic adequacy after sphincter-saving laparoscopic rectal cancer surgery has not been established.
  
  
  METHODS
  Three hundred seventeen consecutive patients underwent sphincter-saving laparoscopic rectal cancer surgery with curative intent performed by single surgeon. The learning curve was estimated using risk-adjusted cumulative sum (RA-CUSUM) and the graph of 195 consecutive patients who were treated by another surgeon was used to evaluate inter-surgeon variability in the learning curve.
  
  
  RESULTS
  Overall, the 3-year local recurrence rate was 7.7% (95% confidence interval [CI], 6.4%-9.0%). The RA-CUSUM analysis demonstrated a learning curve of 110 cases for local recurrence for both of surgeons and 50-70 cases for CRM involvement. The 3-year local recurrence-free rate was better during the experienced period than during the learning period (95.1% [95% CI, 91.6%-97.1%] vs. 89.5% [95% CI, 84.4%-93.0%]; P = 0.029). These differences were obvious in subgroup analysis of stage III tumors (93.4% [95% CI, 86.6%-96.8%] vs. 78.6% [95% CI, 68.5%-85.3%]; P = 0.013).
  
  
  CONCLUSIONS
  Local recurrence rates decreased with increasing surgeon experience, as did other short-term outcomes, especially in advanced disease cases.
authors.affiliation: Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Republic of Korea.
authors.forename: Chang Hyun
authors.initials: CH
authors.lastname: Kim
authors.forename: Hun Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Jung Wook
authors.initials: JW
authors.lastname: Huh
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Hyeong Rok
authors.initials: HR
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*
keywords: laparoscopy; learning curve; local; neoplasm recurrence; rectal cancer