title: The learning curve for laparoscopic colectomy in colorectal cancer at a new regional hospital.
abstract: BACKGROUND
  Laparoscopic colorectal surgery has been extensively used, although mostly performed in medical centers or university hospitals. We analyzed the learning curve of laparoscopic colectomy in a new regional hospital and determined the experience necessary to achieve proficiency.
  
  
  METHODS
  From July 2008 to December 2013, the retrospective clinical study enrolled 240 patients who underwent laparoscopic colectomy. They were sequentially divided into Group A (Patients 1-80), Group B (Patients 81-160), and Group C (Patients 161-240). Patient demographics and perioperative parameters were analyzed. Operation time, as a measure of learning time, was analyzed using the moving-average method.
  
  
  RESULTS
  All patients were comparable for age, gender, body mass index, tumor location, cancer stage, length of hospital stay, intraoperative complication, morbidity, and mortality. Group A experienced more blood loss (p < 0.01) and longer operation time (p < 0.001). All laparoscopic operation time stabilized after 85 cases. Subgroup analysis showed that operation time stabilized after 15 cases for right hemicolectomy, 15 cases for sigmoidectomy, and 22 cases for low anterior resection with total mesorectal excision.
  
  
  CONCLUSIONS
  Laparoscopic colectomy for colorectal cancer in a new regional hospital is feasible and safe. It does not need additional time for learning. Laparoscopic sigmoidectomy can be considered as the initial surgery for a trainee.
authors.affiliation: Division of General Surgery, Department of Surgery, Taipei Medical University, Shuang-Ho Hospital, New Taipei City, Taiwan.
authors.forename: Kuei-Yen
authors.initials: KY
authors.lastname: Tsai
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Taipei Medical University, Shuang-Ho Hospital, New Taipei City, Taiwan.
authors.forename: Kee-Thai
authors.initials: KT
authors.lastname: Kiu
authors.affiliation: Division of General Surgery, Department of Surgery, Taipei Medical University, Shuang-Ho Hospital, New Taipei City, Taiwan.
authors.forename: Ming-Te
authors.initials: MT
authors.lastname: Huang
authors.affiliation: Division of General Surgery, Department of Surgery, Taipei Medical University, Shuang-Ho Hospital, New Taipei City, Taiwan; Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei City, Taiwan.
authors.forename: Chih-Hsiung
authors.initials: CH
authors.lastname: Wu
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Taipei Medical University, Shuang-Ho Hospital, New Taipei City, Taiwan; Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei City, Taiwan. Electronic address: rotring810@yahoo.com.tw.
authors.forename: Tung-Cheng
authors.initials: TC
authors.lastname: Chang
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies
keywords: colorectal cancer; laparoscopic colorectal surgery; learning curve