title: Learning curve for gastric cancer surgery based on actual survival.
abstract: BACKGROUND
  The aim of this study was to investigate learning curves for surgeons performing D2 lymph node dissection based on actual patient survival.
  
  
  METHODS
  A total of 3,284 patients with gastric cancer who underwent curative intent gastric cancer surgery by nine surgeons in eight Korean hospitals between 2001 and 2006 were included. Each surgeon's experience was coded as the number of D1 + β or more gastrectomies performed before that for each patient, which indicates the surgeon's total number of prior surgical experiences. Surgeon experience was grouped into two sets of categories. The set of categories included four groups of experience: ≤50, 51-100, 101-200, and >200 applicable operations. Multivariate survival time regression models were used to evaluate the association between surgeon experience and overall survival.
  
  
  RESULTS
  The learning curve for gastric cancer survival after open gastric cancer surgery was steep and did not reach a plateau until a surgeon completed 100 operations. Overall survival rate was the lowest among patients treated by a surgeon with an experience of 50-100 cases. The overall survival of patients at 5 years when the surgeon had a history of more than 100 experiences was higher in each stage than that when the surgeon had a history of fewer than 100 experiences.
  
  
  CONCLUSIONS
  As a surgeon's experience increases, survival after gastric cancer surgery improves. Special attention needs to be paid to the second period of surgeon experience because survival of patients in this period was the lowest.
authors.affiliation: Center for Gastric Cancer, Gastric Cancer Branch, National Cancer Center, 809 Madu1-dong, Ilsandong-gu, Goyang, Gyeonggi, 411-769, Korea.|Department of Surgery, Chonbuk National University, Jeonju, Korea.
authors.forename: Chan Young
authors.initials: CY
authors.lastname: Kim
authors.affiliation: Center for Gastric Cancer, Gastric Cancer Branch, National Cancer Center, 809 Madu1-dong, Ilsandong-gu, Goyang, Gyeonggi, 411-769, Korea.|Center for Clinical Trial, National Cancer Center, Goyang, Korea.
authors.forename: Byung-Ho
authors.initials: BH
authors.lastname: Nam
authors.affiliation: Center for Gastric Cancer, Gastric Cancer Branch, National Cancer Center, 809 Madu1-dong, Ilsandong-gu, Goyang, Gyeonggi, 411-769, Korea.|Department of Surgery, Soonchunhayng University, Cheonan, Korea.
authors.forename: Gyu Seok
authors.initials: GS
authors.lastname: Cho
authors.affiliation: Center for Gastric Cancer, Gastric Cancer Branch, National Cancer Center, 809 Madu1-dong, Ilsandong-gu, Goyang, Gyeonggi, 411-769, Korea.|Department of Surgery, Yonsei University, Seoul, Korea.
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Hyung
authors.affiliation: Center for Gastric Cancer, Gastric Cancer Branch, National Cancer Center, 809 Madu1-dong, Ilsandong-gu, Goyang, Gyeonggi, 411-769, Korea.|Department of Surgery, Dong-a University, Busan, Korea.
authors.forename: Min Chan
authors.initials: MC
authors.lastname: Kim
authors.affiliation: Center for Gastric Cancer, Gastric Cancer Branch, National Cancer Center, 809 Madu1-dong, Ilsandong-gu, Goyang, Gyeonggi, 411-769, Korea.|Department of Surgery, Seoul National University, Seoul, Korea.
authors.forename: Hyuk-Joon
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Center for Gastric Cancer, Gastric Cancer Branch, National Cancer Center, 809 Madu1-dong, Ilsandong-gu, Goyang, Gyeonggi, 411-769, Korea.|Gastric Cancer Branch, National Cancer Center, Goyang, Korea.
authors.forename: Keun Won
authors.initials: KW
authors.lastname: Ryu
authors.affiliation: Center for Gastric Cancer, Gastric Cancer Branch, National Cancer Center, 809 Madu1-dong, Ilsandong-gu, Goyang, Gyeonggi, 411-769, Korea.|Department of Surgery, Kemyeong University, Daegu, Korea.
authors.forename: Sung Wan
authors.initials: SW
authors.lastname: Ryu
authors.affiliation: Center for Gastric Cancer, Gastric Cancer Branch, National Cancer Center, 809 Madu1-dong, Ilsandong-gu, Goyang, Gyeonggi, 411-769, Korea.|Department of Surgery, Jaeseng Hospital, Seongnam, Korea.
authors.forename: Dong Woo
authors.initials: DW
authors.lastname: Shin
authors.affiliation: Center for Gastric Cancer, Gastric Cancer Branch, National Cancer Center, 809 Madu1-dong, Ilsandong-gu, Goyang, Gyeonggi, 411-769, Korea. gsjunholee@gmail.com.|Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. gsjunholee@gmail.com.
authors.forename: Jun Ho
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy / Q000193:education / Q000706:statistics & numerical data; D006801:Humans; D059032:Learning Curve; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D056910:Republic of Korea; D013274:Stomach Neoplasms / Q000401:mortality* / Q000601:surgery*; D066231:Surgeons / Q000193:education; D015996:Survival Rate; D055815:Young Adult
keywords: Gastric cancer; Learning curve; Surgery