Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer

Kim, Min-Chan; Jung, Ghap Joong; Kim, Hyung‐Ho

doi:10.3748/wjg.v11.i47.7508

Cited by 184 publications

(168 citation statements)

References 22 publications

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“…Reissman et al [22], in their study of 100 laparoscopic colorectal surgeries, stated that the learning curve and the types of procedures affected the morbidity rate. Kim et al [23], in their study of the learning curve for LADG, observed a result similar to the current finding: notable improvement in operating time after 50 surgeries. The notable finding of the current study was a considerable decrease in terms of operative time and development of complication until 50 cases had been managed, then a slight increase after 50 cases, followed by an another decrease and finally a plateau (Fig.…”

Section: Discussionsupporting

confidence: 89%

Complications with laparoscopically assisted gastrectomy: multivariate analysis of 300 consecutive cases

et al. 2008

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Background Complications associated with laparoscopically assisted gastrectomy (LAG) are not significantly different from those associated with open gastrectomy. However, additional risks related to abdominal access, pneumoperitoneum, and special electrosurgical instruments result in an increased incidence of complications with LAG. This study analyzed the causes and risk factors linked to postoperative morbidity. Methods A retrospective review analyzed the data of 300 patients who underwent consecutive LAG for gastric cancer in our department from May 2003 to October 2006. Among the 300 patients, total gastrectomy was performed for 42 patients, distal gastrectomy for 258 patients, and proximal gastrectomy for 3 patients. The clinical and operative data obtained included body mass index, medical comorbidities, history of previous abdominal surgery, operative time, type of surgery, extent of lymph node dissection according to the Japanese Guideline, number of retrieved lymph nodes and lymph node metastases, additional operative procedure, depth of tumor invasion, and disease stage. The outcome data consisted of mortality, major morbidities, and postoperative hospital stay. The 300 cases were divided into two periods: 50 cases in the first period and 250 cases in the second period. Results Postoperative complications developed in 61 cases (20.3%), wound infection in 21 cases (7%), intraabdominal abscess in 3 cases (1%), bleeding in 12 cases (4%), stenosis in 13 cases (4.3%), leakage in 3 cases (1%), acute pancreatitis in 2 cases (0.7%), pulmonary complication in 4 cases (1.3%), renal complication in 4 cases (1.3%), and cardiac complication in 2 cases (0.7%). The 30-day mortality rate was 0.7% (n = 2). Univariate analysis proved that gender, operative period, comorbidity, and operative times were important risk factors. Multivariate analysis proved that cormobidity and operative period were important risk factors. Conclusion The data suggest that LAG can be performed with acceptable perioperative complication rates. The surgeon's experience and careful patient selection determined optimal patient outcomes.

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Section: Discussionsupporting

confidence: 89%

Complications with laparoscopically assisted gastrectomy: multivariate analysis of 300 consecutive cases

et al. 2008

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“…Several previous reports have suggested that LAG with lymph-node dissection may require at least 50-90 cases for a surgeon to gain competence [25][26][27]. It was reported that complications frequently occur during the introductory period, where the greatest of precaution must be taken [3,28].…”

Section: Discussionmentioning

confidence: 99%

Single-institute prospective trial of laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma

et al. 2011

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Background Laparoscopy-assisted gastrectomy (LAG) is an advanced surgery that requires the mastery of complex surgical skills. We evaluate the feasibility of LAG with systemic lymph node dissection when participating surgeons have sufficient knowledge and experience to conduct open surgery for gastric cancer and basic laparoscopic skills. Methods All operations were performed by two Japan Surgical Society board-certified attending surgeons who had performed over 50 conventional gastrectomies and 30 laparoscopic cholecystectomies. The surgeons went through an established program, including training at the wet and dry laboratories. In addition, surgeries for the first 10 cases were assisted by an expert surgeon with experience of [300 cases. To be eligible for the LAG procedure, patients had to have a preoperative diagnosis of T1, N0 and M0 gastric carcinoma. The morbidity rate was used as the study endpoint. Variables such as operating time, intraoperative blood loss and number of retrieved lymph nodes were evaluated as complementary surgical endpoints. These variables were compared between the first 25 cases and the latter 25 cases.Results A total of 50 patients who were scheduled to undergo LAG were prospectively enrolled between 2005 and 2008. Morbidity rate was 4% (2/50), with one case due to intestinal injury and one case due to an intra-abdominal abscess. Complications related to laparoscopy were observed in 2% (1/50), with one case of mesenteric injury. The conversion rate to laparotomy was 6% (3/50). However, there were no serious consequences in converted cases. The operating time was 263.7 ± 45.0 min. The intraoperative blood loss was 94.5 ± 106.5 g. The total number of regional lymph nodes retrieved was 34.7 ± 12.2. A significant improvement in the blood loss was only noted after the first 25 procedures. All patients are alive and disease-free after a median follow-up of 38.8 months. Conclusion An adequate training program, including site visits by expert surgeons, in conjunction with basic laparoscopy skills and solid backgrounds in open gastrectomy from the perspective of the trainees are currently key to the successful and safe implementation of LAG. Whether the procedure is oncologically feasible remains to be confirmed by long-term follow-up.

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“…There were no significant differences in hospital mortality. DFS in LTG was similar to that in OTG (HR, 0.62; 95% CI, 0.30, 1.27; P= 0.191) (Fig.2-3) [1][2][3][12][13][14][15][16][17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

“…In the past subtotal or total gastrectomy was always performed with open technique. In 1991 The Japanese school of gastric resection led by Professor Kitano performed the first Laparoscopic Subtotal Gastrectomy (LSG) for Early Gastric Cancer (EGC) [2][3][4][5][6][7][8]. Since this first reported surgery, Laparoscopic Gastrectomy (LG) has gained popularity in the last 20 years.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Subtotal/Total Gastrectomy (LS/TG) Versus Open Subtotal/Total Gastrectomy (OS/TG) For Gastric Cancer: Literature Review to Activate the Laparoscopic Procedure Gastric Cancer Resection in Secondary Care Hospital

Coco¹

2017

MOJCR

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Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer

Abstract: Based on operative time analysis, this study show that experience of 50 cases of LADG with systemic lymphadenectomy for early gastric cancer is required to achieve optimum proficiency.

Cited by 184 publications

References 22 publications

Complications with laparoscopically assisted gastrectomy: multivariate analysis of 300 consecutive cases

Complications with laparoscopically assisted gastrectomy: multivariate analysis of 300 consecutive cases

Single-institute prospective trial of laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma

Laparoscopic Subtotal/Total Gastrectomy (LS/TG) Versus Open Subtotal/Total Gastrectomy (OS/TG) For Gastric Cancer: Literature Review to Activate the Laparoscopic Procedure Gastric Cancer Resection in Secondary Care Hospital

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