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

Kim, Ki Han; Kim, Min chan; Jung, Ghap Joong; Kim, Hyung Ho

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.