title: Learning curve for single-port laparoscopic colon cancer resection: a multicenter observational study.
abstract: The aim of this study was to investigate the learning curves (LCs) of single-port laparoscopic surgery (SPLS) for colon cancer using multidimensional statistical analyses. Although SPLS yields better cosmetic results and comparable short-term outcomes compared to conventional laparoscopic surgery, its technical difficulties make surgeons hesitant to try SPLS. Moreover, the LCs of SPLS for colon cancer are not well delineated.
  
  
  
  Data were collected from patients who underwent SPLS for colon cancer in seven Korean institutions between May 2009 and May 2015. The LCs were analyzed using the moving average method and the cumulative sum control chart (CUSUM) for operation time and surgical failure. Surgical failure was defined as the any conversion, postoperative complications, or less than 12 harvested lymph nodes from surgical specimens.
  
  
  
  A total of 356 patients were included in this study. Six and three surgeons performed 282 anterior resections (ARs) and 74 right colectomies (RCs), respectively. On the basis of the moving average method and CUSUM for operation time and surgical failure, the LCs for AR were 18, 16, 35, 13, 36, and 13 cases for surgeons A-F, respectively. However, the LCs for RC were 6 and 15 cases for surgeons D and E, respectively, and were ambiguous for one surgeon.
  
  
  
  For surgeons experienced in conventional laparoscopic colorectal surgery, the LCs of SPLS for colon cancer ranged from 6 to 36 cases, which is shorter than the LCs reported for conventional laparoscopic surgery.
authors.affiliation: Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892, Dongnam-ro, Gangdong-gu, Seoul, 05278, Korea.
authors.forename: Chang Woo
authors.initials: CW
authors.lastname: Kim
authors.affiliation: Department of Surgery, Kyung Hee Medical Center, Kyung Hee University School of Medicine, Seoul, Korea.
authors.forename: Kil Yeon
authors.initials: KY
authors.lastname: Lee
authors.affiliation: Department of Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea.
authors.forename: Sang Chul
authors.initials: SC
authors.lastname: Lee
authors.affiliation: Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892, Dongnam-ro, Gangdong-gu, Seoul, 05278, Korea. leeshdr@gmail.com.
authors.forename: Suk-Hwan
authors.identifier: 0000-0001-6470-8620
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea.
authors.forename: Yoon Suk
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea.
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Lim
authors.affiliation: Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: Jun-Gi
authors.initials: JG
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: CUSUM; Colon cancer; Learning curve; Moving average; Single-port laparoscopic surgery; Single-port surgery