Background: Laparoscopy-assisted gastrectomy (LAG) is a complex and time-consuming procedure, which is increasingly used for early gastric cancer (EGC). We provide a multidimensional analysis of the learning curve in LAG. Methods: Cumulative sum method was used to analyze outcomes of 109 patients undergoing LAG for EGC by one surgeon over a two year period; the influence of patient selection was evaluated. Target failure rate was set at 10%, with failure defined as open conversion, mortality, major morbidity, residual tumor, or inappropriate lymphadenectomy. Results: There were 19 failures-fourteen performance and five oncologic. The learning curve, which displayed a slight rising trend and three phases was achieved after 40 cases with selected patients; it was broken, however, by the introduction of advanced procedures and unselected patients. Conclusions: Advanced procedures and broad indications in LAG should be delayed until a learning curve is completed under the target failure rate.

Angelica polymorpha Maxim. (APM) is used in traditional medicine to treat chronic gastritis, rheumatic pain, and duodenal bulbar ulcers. However, it is not known whether APM has epidermis-associated biological activities. Here, we investigated the effects of APM flower absolute (APMFAb) on responses associated with skin wound healing and whitening using epidermal cells. APMFAb was obtained by solvent extraction and its composition was analyzed by GC/MS. Water-soluble tetrazolium salt, 5-bromo-2′-deoxyuridine incorporation, Boyden chamber, sprouting, and enzyme-linked immunosorbent assays and immunoblotting were used to examine the effects of APMFAb on HaCaT keratinocytes and B16BL6 melanoma cells. APMFAb contained five compounds and induced keratinocyte migration, proliferation, and type IV collagen synthesis. APMFAb also induced the phosphorylations of ERK1/2, JNK, p38 mitogen-activated protein kinase, and AKT in keratinocytes. In addition, APMFAb decreased serum-induced B16BL6 cell proliferation and inhibited tyrosinase expression, melanin contents, and microphthalmia-associated transcription factor expression in α-melanocyte-stimulating hormone-stimulated B16BL6 cells. These findings demonstrate that APMFAb has beneficial effects on skin wound healing by promoting the proliferation, migration, and collagen synthesis of keratinocytes and on skin whitening by inhibiting melanin synthesis in melanoma cells. Therefore, we suggest that APMFAb has potential use as a wound healing and skin whitening agent.