The Learning Curve in Laparoscopy Assisted Distal Gastrectomy (LADG) with Systemic Lymphadenectomy for Early Gastric Cancer Considering the Operation Time

ABSTRACT

PURPOSE: Laparoscopy assisted distal gastrectomy has become a feasible and acceptable surgical technique for treating early gastric cancer. However, there is no report on the learning curve of LADG with a systemic lymphadenectomy for early gastric cancer. The aim of this study is to evaluate the nature of the learning curve for LADG with a systemic lymphadenectomy for early gastric cancer. METHODS: The data from 90 consecutive patients with early gastric cancer who had undergone a LADG with a systemic lymphadenectomy between April 2003 and November 2004 were reviewed. The operation times of 90 consecutive patients were reviewed. Other indicators such as the trans-fusion requirements, postoperative complications, time to first flatus, and postoperative hospital stay were also evaluated. RESULTS: Mean operation time was 227.2 minutes. Of the 22 patients with a submucosal lesion, two patients had one metastatic lymph node, and of the 66 patients with a mucosal lesion, one patient had one metatstatic lymph node. Sixty-seven (74.4%) patients underwent a B-I reconstruction and 79 patients (87.8%) underwent a systemic lymphadenectomy above D1+beta. After the first 10 LADGs, the operative time reached its first plateau (230~240 minutes/operation), and then reached a second plateau (<200 minutes/operation) for the final 30 cases. Although a significant improve-ment in operative time was noted after the first 50 cases, there were no significant differences in the other postoperative outcomes. CONCLUSION: Based on operative time analysis, this study shows that the experience of 50 cases of LADG with systemic lymphadenectomy for gastric cancer are needed to achieve the optimum proficiency.