Learning Curve for Total Gastrectomy with D2 Lymph Node Dissection: Cumulative Sum Analysis for Qualified Surgery

Authors: Lee, Jun; Ryu, Keun; Lee, Jin-Hee; Park, Sook; Kim, Chan; Kook, Myoung; Nam, Byung-Ho; Kim, Young-Woo; Bae, Jae-Moon

Source: Annals of Surgical Oncology, Volume 13, Number 9, September 2006 , pp. 1175-1181(7)

Publisher: Springer

Buy & download fulltext article:

Price: $47.00 plus tax (Refund Policy)

Abstract:

This study was conducted to evaluate the leaning curve of D2 lymph node dissection for patients with gastric cancer in a high-volume center.

The authors prospectively reviewed the data of all patients who underwent total gastrectomy with D2 lymph node dissection during a 4-year period. Retrieved lymph node number was used as a surrogate marker of oncological outcome. The retrieved lymph node number cut-off value required for satisfactory D2 lymph node dissection was defined as >25. Cumulative sum analysis was used to examine the learning curves of individual surgeons at target accuracy rates of 85%, 90%, 92.5%, 95%, and 98%.

Two junior staff surgeons performed 198 curative-intent total gastrectomies with D2 lymph node dissections during the study period; their success rates exceeded 90%. Operating time decreased with operative experience (Pearson correlation coefficient = −0.515, P < 0.001). The learning period for total gastrectomy with D2 lymph node dissection for these two junior members of staff was calculated as 23-35 cases, presuming a 92.5% success rate.

The current study suggests that the surgical learning period for D2 lymph node dissection extends to at least 23 cases or 8 months. In clinical trials containing gastric cancer surgery, the learning curve for qualified surgery from the standpoint of oncological outcome should be considered to minimize bias due to surgeon-associated factors.

Keywords: Gastric cancer; Total gastrectomy; D2 lymph node dissection; Learning curve; Cumulative sum analysis

Document Type: Research article

DOI: http://dx.doi.org/10.1245/s10434-006-9050-8

Affiliations: 1: Email: docryu@korea.com

Publication date: 2006-09-01

Learning Curve for Total Gastrectomy with D2 Lymph Node Dissection: Cumulative Sum Analysis for Qualified Surgery

Buy & download fulltext article:

Tools

Key

Text size:

Useful pages