Short-term outcomes of laparoscopic-assisted distal gastrectomy for gastric cancer during a surgeon’s learning curve period

Yoo, Chai H.; Kim, Hyung Ook; Hwang, Sungsoon; Son, Byung Ho; Shin, Jun Ho; Kim, Hungdai

doi:10.1007/s00464-008-0315-0

Cited by 69 publications

(49 citation statements)

References 29 publications

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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]. In the current study, blood loss was the only parameter that showed a significant difference between the first and last 25 cases.…”

Section: Discussionsupporting

confidence: 43%

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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Section: Discussionsupporting

confidence: 43%

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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“…However, these reports involved only small numbers of cases. When the outcomes of LTG and OTG are compared, the learning curve should also be considered [19,20]. Thus, the experience of the surgeons should be checked before a prospective study, including randomized clinical trials, to minimize bias resulting from operatorassociated factors [21].…”

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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“…Although several studies comparing LADG with ODG in terms of short-term results have been reported from Far Eastern countries, there were few studies that compared LADG with ODG after excluding surgical risk factors which could influence the clinical outcomes [9]. In addition, studies regarding a learning curve effect of LADG are still very limited [10].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopy-Assisted Distal Gastrectomy Compared to Open Distal Gastrectomy in Early Gastric Cancer

Han

Lee²,

Han³

et al. 2011

Dig Surg

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Background: This study aimed to evaluate the feasibility of laparoscopy-assisted distal gastrectomy (LADG) in early gastric cancer (EGC) with special interest in a learning curve effect. Methods: The clinical outcomes of EGC patients who underwent LADG (n = 100) and sex-, age- and body mass index- (BMI) matched EGC patients who underwent open distal gastrectomy (ODG; n = 100) were compared retrospectively. In addition, the outcomes between the early (n = 50) and late LADG group (n = 50) were compared. Results: The mean number of retrieved lymph nodes was significantly smaller in the LADG group than in the ODG group (29.3 vs. 36.4, p < 0.001). The operative time of the LADG group was significantly longer than in the ODG group (249.1 vs. 152.9 min, p < 0.001). The complication rates were comparable between both groups (14 vs. 13%, p = 0.84). No cancer-related death was observed in either group. Between early and late LADG groups, the operative time was shorter (p < 0.001) and the number of retrieved lymph nodes was higher (p = 0.016) in the late group. Conclusions: LADG seems to be a safe and feasible procedure in treating EGC, as it shows comparable outcomes with ODG. The potential disadvantages of LADG, such as longer operation time and smaller number of retrieved lymph nodes, diminished after overcoming the learning curve.

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Short-term outcomes of laparoscopic-assisted distal gastrectomy for gastric cancer during a surgeon’s learning curve period

Cited by 69 publications

References 29 publications

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

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

The learning curve associated with laparoscopic total gastrectomy

Laparoscopy-Assisted Distal Gastrectomy Compared to Open Distal Gastrectomy in Early Gastric Cancer

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