Comparison of Learning Curves and Clinical Outcomes between Laparoscopy-assisted Distal Gastrectomy and Open Distal Gastrectomy

Kang, Suhyun; Lee, Se Youl; Kim, Chan Young; Yang, Doo Hyun

doi:10.5230/jgc.2010.10.4.247

Cited by 38 publications

(36 citation statements)

References 15 publications

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“…Therefore, the higher incidence of DSF in the laparoscopic approach should be interpreted as an effect of the normal learning curve in our experience, as it is also reported and well documented in several articles in literature [47][48][49][50].…”

Section: Discussionmentioning

confidence: 73%

Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience

et al. 2014

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Background Duodenal stump fistula (DSF) is the most severe surgical complication after gastrectomy. This study was designed to assess the incidence, to observe the consequences, and to identify the risk factors associated with DSF after gastrectomy. Methods All procedures involving total or sub-total gastrectomy for cancer, performed between January 1987 and June 2012 in a single institution, were prospectively entered into a computerized database. Risk factors analysis was performed between DSF patients, patients with complete uneventful postoperative course and patients with other major surgical complications. Results Over this 25 years period, 1287 gastrectomies were performed. DSF was present in 32 cases (2.5 %). Mean post-operative onset was 6.6 days. 19 patients were treated conservatively and 13 surgically. Mean DSF healing time was 31.2 and 45.2 days in the two groups, respectively. Mortality was registered in 3 cases (9.37 %), due to septic shock (2 cases) and bleeding (1 case). In monovariate analysis, heart disease (p \ 0.001), pre-operative lymphocytes number (p = 0.003) and absence of manual reinforcement over duodenal stump (p \ 0.001) were found to be DSF-specific risk factors, whereas liver cirrhosis (p = 0.002), pre-operative albumin levels (p \ 0.001) and blood losses (p = 0.002) were found to be non-DSF-specific risk factors. In multivariate analysis heart disease (OR 5.18; p \ 0.001), liver cirrhosis (OR 13.2; p \ 0.001), bio-humoral nutritional status impairment (OR 2.29; p = 0.05), blood losses [300 mL (OR 4.47; p = 0.001) and absence of manual reinforcement over duodenal stump (OR 30.47; p \ 0.001) were found to be independent risk factors for DSF development. Conclusions Duodenal stump fistula still remains a lifethreatening complication after gastric surgery. Co-morbidity factors, nutritional status impairment and surgical technical difficulties should be considered as important risk factors in developing this awful complication.

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Section: Discussionmentioning

confidence: 73%

Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience

et al. 2014

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“…Gui-Xiang Liao 1,2& , Guo-Zhu Xie 1& , Rong Li 1 , Zhi-Hong Zhao 3 , Quan-Quan Sun 1 , Sha-Sha Du 1 , Chen Ren 1 , Guo-Xing Li 2 , Hai-Jun Deng 2 , Ya-Wei Yuan 1 * and long, especially in lymph node dissection (Kang et al, 2010). To overcome these limitations, robot-assisted surgery provides potential countermeasures.…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of Outcomes Compared between Robotic and Laparoscopic Gastrectomy for Gastric Cancer

Liao

Xie²,

Li³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…However, thus far there have been few published descriptions on the learning process associated with LADG [14][15][16][17][18]. Kang et al [14] reported that progression along the learning curve as represented by decreased operation time is more apparent in the first 20 cases of LADG than in the first 20 cases of ODG, but surgeons reached a plateau in operation time after performing 50 LADG cases. In another report, Kim et al [15] analyzed the data of 90 consecutive patients with early gastric cancer who un-derwent LADG with systemic lymphadenectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Because laparoscopic gastrectomy has been reported to have substantial advantages over conventional operations, such as less postoperative pain, faster recovery, and better cosmetic results, many gastric surgeons have a high level of interest in learning the technique [8][9][10][11]. However, thus far there have been few published descriptions on the learning process associated with LADG [14][15][16][17][18]. Kang et al [14] reported that progression along the learning curve as represented by decreased operation time is more apparent in the first 20 cases of LADG than in the first 20 cases of ODG, but surgeons reached a plateau in operation time after performing 50 LADG cases.…”

Section: Discussionmentioning

confidence: 99%

“…Although many reports have presented the various surgical technique of LADG, few reports have described the learning curve associated LADG [14][15][16][17][18], and none has shown whether direct instructions by a surgeon experienced surgeon in LADG can shorten the learning curve. In this report, we retrospectively evaluated the learning curve for LADG of a single surgeon with no prior experience in performing LADG.…”

Section: Introductionmentioning

confidence: 99%

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Direct Instruction by an Experienced Surgeon Can Shorten the Learning Curve for Laparoscopic-Assisted Distal Gastrectomy

Takemura¹,

Mayumi²,

Ikebe³

et al. 2013

IJCM

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Aim: Laparoscopy-assisted distal gastrectomy (LADG) with regional lymph node dissection is a treatment option for patient with early gastric cancer. However, LADG is a technically complex and advanced procedure, which is challenging for inexperienced surgeons. In this report, we retrospectively evaluated the learning curve for LADG of a single surgeon with no previous experience in LADG and the usefulness of direct instruction by a surgeon experienced in LADG in shortening the learning curve. Patients and Methods: This study was analyzed 80 consecutive patients, who underwent LADG by a single surgeon (first assistant in 10 cases and operator in 70 cases) between January 2008 and December 2012. Patients were divided into 3 sequential groups of 10 (training period), 30 (learning period), and 40 (operating period) cases in each group. Median operation time and estimated blood loss for these 3 groups were determined. Other learning indicators, including transfusion requirement, postoperative complications, number of lymph node harvested, and rate of conversion open gastrectomy, were also evaluated. Results: During the training period, median operation time and estimated blood loss were 219.5 min and 83.0 ml, respectively. During the learning period, the operation time was significantly longer than that of training period. In the operating period, the operation time was significantly lesser than that during the learning period. However, the operation time was not different from that during the training period and reached a plateau. The estimated blood loss during the operating period was significantly lesser than that during the learning period. The difference in the number of lymph nodes retrieved between each group was not significant. Conclusions: Direct instructions by an experienced surgeon can decrease the number of cases required for learning. Because LADG is technically more complex than other laparoscopic procedures, standardization of LADG and an effective training system for performing it should be established.

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Comparison of Learning Curves and Clinical Outcomes between Laparoscopy-assisted Distal Gastrectomy and Open Distal Gastrectomy

Cited by 38 publications

References 15 publications

Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience

Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience

Meta-analysis of Outcomes Compared between Robotic and Laparoscopic Gastrectomy for Gastric Cancer

Direct Instruction by an Experienced Surgeon Can Shorten the Learning Curve for Laparoscopic-Assisted Distal Gastrectomy

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