Learning Curve and Long-Term Outcomes of Laparoscopy-Assisted Distal Gastrectomy for Gastric Cancer

Abstract

Abstract

Objective:

To discuss the learning curve of laparoscopy-assisted distal gastrectomy (LADG) with lymph node dissection and the oncological results and long-term outcomes of different periods in the learning stage.

Patients and Methods:

One hundred twenty-four patients with gastric cancer who received LADG with lymph node dissection from January 2004 to December 2009 were retrospectively reviewed and analyzed. They were divided into three groups (A–C) according to different operative date: 41 were in Group A (early), 41 in Group B (middle), and 42 in Group C (laer). There were no significant statistical differences among the three groups with respect to age, gender, early/advanced gastric cancer, Union for International Cancer Control stage, and lymph node dissection. Then the following items were compared in these groups: operative time, blood loss, number of lymph nodes harvested, postoperative complications, postoperative hospital stay, and long-term survival.

Results:

The operative time in Group A (235.0±50.3 minutes) was significantly longer than in Groups B (201.7±39.6 minutes) and C (199.0±44.7 minutes), but there was no significant difference between Groups B and C. The harvest of lymph nodes from Group A (11.0±5.5) was significantly less than from Groups B (16.3±9.2) and C (17.2±8.7), but there was no significant difference between Groups B and C. The postoperative hospital stay and complications, overall survival, and disease-free survival showed no difference among the three groups.

Conclusions:

The learning curve of gastrointestinal surgeons with experience of laparoscopic operation is about 40 cases. The oncological principles and long-term outcomes were not sacrificed during the learning stage.