title: Lessons learned from a comparative analysis of surgical outcomes of and learning curves for laparoscopy-assisted distal gastrectomy.
abstract: OBJECTIVE
  Before expanding our indications for laparoscopic gastrectomy to advanced gastric cancer and adopting reduced port laparoscopic gastrectomy, we analyzed and audited the outcomes of laparoscopy-assisted distal gastrectomy (LADG) for adenocarcinoma; this was done during the adoptive period at our institution through the comparative analysis of short-term surgical outcomes and learning curves (LCs) of two surgeons with different careers.
  
  
  METHODS
  A detailed comparative analysis of the LCs and surgical outcomes was done for the respective first 95 and 111 LADGs performed by two surgeons between July, 2006 and June, 2011. The LCs were fitted by using the non-linear ordinary least squares estimation method.
  
  
  RESULTS
  The postoperative morbidity and mortality rates were 14.6% and 0.0%, respectively, and there was no significant difference in the morbidity rates (12.6% vs. 16.2%, P=0.467). More than 25 lymph nodes were retrieved by each surgeon during LADG procedures. The LCs of both surgeons were distinct. In this study, a stable plateau of the LC was not achieved by both surgeons even after performing 90 LADGs.
  
  
  CONCLUSIONS
  Regardless of the experience with gastrectomy or laparoscopic surgery for other organs, or the age of surgeon, the outcome was quite acceptable; the learning process differ according to the surgeon's experience and individual characteristics.
authors: Department of Surgery, Korea University College of Medicine, College of Natural Sciences, Sungshin Women's University, Seoul, Korea.
authors: Jun-Seok
authors: JS
authors: Moon
authors: Department of Statistics, College of Natural Sciences, Sungshin Women's University, Seoul, Korea.
authors: Man Sik
authors: MS
authors: Park
authors: Department of Surgery, Korea University College of Medicine, College of Natural Sciences, Sungshin Women's University, Seoul, Korea.
authors: Jong-Han
authors: JH
authors: Kim
authors: Department of Surgery, Korea University College of Medicine, College of Natural Sciences, Sungshin Women's University, Seoul, Korea.
authors: You-Jin
authors: YJ
authors: Jang
authors: Department of Surgery, Korea University College of Medicine, College of Natural Sciences, Sungshin Women's University, Seoul, Korea.
authors: Sung-Soo
authors: SS
authors: Park
authors: Department of Surgery, Korea University College of Medicine, College of Natural Sciences, Sungshin Women's University, Seoul, Korea.
authors: Young-Jae
authors: YJ
authors: Mok
authors: Department of Surgery, Korea University College of Medicine, College of Natural Sciences, Sungshin Women's University, Seoul, Korea.
authors: Seung-Joo
authors: SJ
authors: Kim
authors: Department of Surgery, Korea University College of Medicine, College of Natural Sciences, Sungshin Women's University, Seoul, Korea.
authors: Chong-Suk
authors: CS
authors: Kim
authors: Department of Surgery, Korea University College of Medicine, College of Natural Sciences, Sungshin Women's University, Seoul, Korea.
authors: Seong-Heum
authors: SH
authors: Park
keywords: Gastrectomy; Laparoscopy; Learning curve; Treatment outcome