Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer

Jin, Sung‐Ho; Kim, Do-Yoon; Kim, Hong; Jeong, In Ho; Kim, Myung-Wook; Cho, Yong Kwan; Han, Sang‐Uk

doi:10.1007/s00464-005-0634-3

Cited by 132 publications

(112 citation statements)

References 18 publications

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“…Therefore, a significant learning curve for LTG is associated with the mastering these operative techniques. Theoretically, ideal approaches for conducting statistical assessments of learning curves such as multivariate logistic regression or the cumulative sum (CUSUM) method have been used recently [13][14][15]. Commonly used outcomerelated variables, such as conversion to open surgery and the occurrence of severe complications, were also evaluated in the present study and were considered very useful for monitoring operative performance.…”

Section: Discussionmentioning

confidence: 99%

The learning curve associated with laparoscopic total gastrectomy

et al. 2014

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Background Although the frequency of laparoscopic total gastrectomy (LTG) has been increasing, the procedure requires considerable experience because of its technical difficulty and the concern for oncological safety. This study intended to define the learning curve associated with the procedure. Methods All 256 cases of LTG performed from June 2003 to December 2012 were enrolled. The cases were divided into ten groups of 25 cases based on when they occurred. The learning curve was defined using the moving average method. LTG, performed in the absence of other procedures (pure-LTG, 132 cases), was extracted from the ten groups, and the mean operative time and estimated blood loss (EBL) were compared to define the learning curve. Retrieved lymph nodes, hospital stay, and complications were compared across the phases of the learning curve. LTG with spleen resection, performed in the absence of other procedures (pure-srLTG, 53 cases), was also analyzed by the same method. Results A three-phase learning curve of LTG was defined: the first two groups, the following two groups, and the final six groups (mean operative time: 223.0, 244.8, and 207.8 min, respectively, p = 0.003; mean EBL: 94.6, 237.0, and 116.5 ml, respectively, p \ 0.001). The rates of complications and open conversions were similar across the three phases. There were no significant differences in mean operative time, EBL, retrieved LNs, hospital stay, or complication rates between pure-LTG and pure-srLTG, after completing the respective learning curves. Conclusions Experience with approximately 100 LTG cases was required to complete learning of the procedure.

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Section: Discussionmentioning

confidence: 99%

The learning curve associated with laparoscopic total gastrectomy

et al. 2014

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“…We suggest that advanced procedures and extension of indications in LAG should be delayed until a learning curve is completed and the failure rate is less than for a multidimensional learning curve [12]. Therefore, a much larger number of cases is needed for a risk analysis of complications in LAG.…”

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confidence: 99%

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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“…In addition to this, they also showed better LND, faster oral intake, reduced pain, earlier hospital discharge, the same M/M and similar anastomotic leakage or stenosis, and similar LTS-DFS-OS compared to OG. As far as port site some Author has reported negative results [10][11][12][13][14] while other authors have noticed that the time is shorter and closer to open technique when a dedicated laparoscopic team perform at least 50 LG [4,5]. Recently, Haverkamp et al meta-analysis have showed the superiority of LG vs OG but oncological outcomes are still being debated [2,11].…”

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

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2017

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Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer

Cited by 132 publications

References 18 publications

The learning curve associated with laparoscopic total gastrectomy

The learning curve associated with laparoscopic total gastrectomy

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

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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