Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
권호 표지
DOI QR코드

DOI QR Code

Totally Laparoscopic Distal Gastrectomy after Learning Curve Completion: Comparison with Laparoscopy-Assisted Distal Gastrectomy

  • Kim, Han-Gil (Department Surgery, Postgraduate School of Medicine, Gyeongsang National University) ;
  • Park, Ji-Ho (Department Surgery, Postgraduate School of Medicine, Gyeongsang National University) ;
  • Jeong, Sang-Ho (Department Surgery, Postgraduate School of Medicine, Gyeongsang National University) ;
  • Lee, Young-Joon (Department Surgery, Postgraduate School of Medicine, Gyeongsang National University) ;
  • Ha, Woo-Song (Department Surgery, Postgraduate School of Medicine, Gyeongsang National University) ;
  • Choi, Sang-Kyung (Department Surgery, Postgraduate School of Medicine, Gyeongsang National University) ;
  • Hong, Soon-Chan (Department Surgery, Postgraduate School of Medicine, Gyeongsang National University) ;
  • Jung, Eun-Jung (Department Surgery, Postgraduate School of Medicine, Gyeongsang National University) ;
  • Ju, Young-Tae (Department Surgery, Postgraduate School of Medicine, Gyeongsang National University) ;
  • Jeong, Chi-Young (Department Surgery, Postgraduate School of Medicine, Gyeongsang National University) ;
  • Park, Taejin (Department Surgery, Postgraduate School of Medicine, Gyeongsang National University)
  • Received : 2013.01.30
  • Accepted : 2013.03.06
  • Published : 2013.03.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The aims are to: (i) display the multidimensional learning curve of totally laparoscopic distal gastrectomy, and (ii) verify the feasibility of totally laparoscopic distal gastrectomy after learning curve completion by comparing it with laparoscopy-assisted distal gastrectomy. Materials and Methods: From January 2005 to June 2012, 247 patients who underwent laparoscopy-assisted distal gastrectomy (n=136) and totally laparoscopic distal gastrectomy (n=111) for early gastric cancer were enrolled. Their clinicopathological characteristics and early surgical outcomes were analyzed. Analysis of the totally laparoscopic distal gastrectomy learning curve was conducted using the moving average method and the cumulative sum method on 180 patients who underwent totally laparoscopic distal gastrectomy. Results: Our study indicated that experience with 40 and 20 totally laparoscopic distal gastrectomy cases, is required in order to achieve optimum proficiency by two surgeons. There were no remarkable differences in the clinicopathological characteristics between laparoscopy-assisted distal gastrectomy and totally laparoscopic distal gastrectomy groups. The two groups were comparable in terms of open conversion, combined resection, morbidities, reoperation rate, hospital stay and time to first flatus (P>0.05). However, totally laparoscopic distal gastrectomy had a significantly shorter mean operation time than laparoscopy-assisted distal gastrectomy (P<0.01). We also found that intra-abdominal abscess and overall complication rates were significantly higher before the learning curve than after the learning curve (P<0.05). Conclusions: Experience with 20~40 cases of totally laparoscopic distal gastrectomy is required to complete the learning curve. The use of totally laparoscopic distal gastrectomy after learning curve completion is a feasible and timesaving method compared to laparoscopy-assisted distal gastrectomy.

Keywords

References

  1. Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 2010;251:417-420. https://doi.org/10.1097/SLA.0b013e3181cc8f6b
  2. Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N; Japanese Laparoscopic Surgery Study Group. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 2007;245:68-72. https://doi.org/10.1097/01.sla.0000225364.03133.f8
  3. Song KY, Park CH, Kang HC, Kim JJ, Park SM, Jun KH, et al. Is totally laparoscopic gastrectomy less invasive than laparoscopy- assisted gastrectomy?: prospective, multicenter study. J Gastrointest Surg 2008;12:1015-1021. https://doi.org/10.1007/s11605-008-0484-0
  4. Hosogi H, Kanaya S. Intracorporeal anastomosis in laparoscopic gastric cancer surgery. J Gastric Cancer 2012;12:133-139. https://doi.org/10.5230/jgc.2012.12.3.133
  5. Kim MG, Kawada H, Kim BS, Kim TH, Kim KC, Yook JH, et al. A totally laparoscopic distal gastrectomy with gastroduodenostomy (TLDG) for improvement of the early surgical outcomes in high BMI patients. Surg Endosc 2011;25:1076-1082. https://doi.org/10.1007/s00464-010-1319-0
  6. Jin SH, Kim DY, Kim H, Jeong IH, Kim MW, Cho YK, et al. Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer. Surg Endosc 2007;21:28-33. https://doi.org/10.1007/s00464-005-0634-3
  7. Kim MC, Jung GJ, Kim HH. Learning curve of laparoscopyassisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer. World J Gastroenterol 2005;11:7508- 7511.
  8. Fujiwara M, Kodera Y, Miura S, Kanyama Y, Yokoyama H, Ohashi N, et al. Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: a phase II study following the learning curve. J Surg Oncol 2005;91:26-32. https://doi.org/10.1002/jso.20166
  9. Zhang X, Tanigawa N. Learning curve of laparoscopic surgery for gastric cancer, a laparoscopic distal gastrectomy-based analysis. Surg Endosc 2009;23:1259-1264. https://doi.org/10.1007/s00464-008-0142-3
  10. Novick RJ, Stitt LW. The learning curve of an academic cardiac surgeon: use of the CUSUM method. J Card Surg 1999;14:312-320. https://doi.org/10.1111/j.1540-8191.1999.tb01001.x
  11. Strasberg SM, Linehan DC, Hawkins WG. The accordion severity grading system of surgical complications. Ann Surg 2009;250:177-186. https://doi.org/10.1097/SLA.0b013e3181afde41
  12. Williams SM, Parry BR, Schlup MM. Quality control: an application of the cusum. BMJ 1992;304:1359-1361. https://doi.org/10.1136/bmj.304.6838.1359
  13. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010;17:1471-1474. https://doi.org/10.1245/s10434-010-0985-4
  14. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011;14:101-112. https://doi.org/10.1007/s10120-011-0041-5
  15. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011;14:113-123. https://doi.org/10.1007/s10120-011-0042-4
  16. Joo YT, Moon HG, Lee SH, Jeong CY, Jung EJ, Hong SC, et al. Laparoscopy-assisted distal gastrectomy with intracorporeal Billroth I stapled anastomosis using a hand access device for patients with gastric cancer. Surg Endosc 2007;21:859-862. https://doi.org/10.1007/s00464-006-9060-4
  17. Kanaya S, Gomi T, Momoi H, Tamaki N, Isobe H, Katayama T, et al. Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg 2002;195:284-287. https://doi.org/10.1016/S1072-7515(02)01239-5
  18. Hyung WJ, Lim JS, Cheong JH, Kim J, Choi SH, Song SY, et al. Intraoperative tumor localization using laparoscopic ultrasonography in laparoscopic-assisted gastrectomy. Surg Endosc 2005;19:1353-1357. https://doi.org/10.1007/s00464-004-8196-3
  19. Kim HI, Hyung WJ, Lee CR, Lim JS, An JY, Cheong JH, et al. Intraoperative portable abdominal radiograph for tumor localization: a simple and accurate method for laparoscopic gastrectomy. Surg Endosc 2011;25:958-963. https://doi.org/10.1007/s00464-010-1288-3
  20. Tanimura S, Higashino M, Fukunaga Y, Osugi H. Laparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer. Surg Endosc 2003;17:758-762. https://doi.org/10.1007/s00464-002-8625-0
  21. Jeong O, Cho SB, Joo YE, Ryu SY, Park YK. Novel technique for intraoperative tumor localization during totally laparoscopic distal gastrectomy: endoscopic autologous blood tattooing. Surg Endosc 2012;26:1778-1783. https://doi.org/10.1007/s00464-011-2067-5
  22. Jeong SH, Lee YJ, Bae K, Ha WS, Park ST, Choi SK, et al. Clinical factors affecting the length of minilaparotomy incision in laparoscopy-assisted distal gastrectomy. J Laparoendosc Adv Surg Tech A 2009;19:129-133. https://doi.org/10.1089/lap.2008.0112
  23. Lee J, Kim D, Kim W. Comparison of laparoscopy-assisted and totally laparoscopic Billroth-II distal gastrectomy for gastric cancer. J Korean Surg Soc 2012;82:135-142. https://doi.org/10.4174/jkss.2012.82.3.135
  24. Park DJ, Lee HJ, Kim HH, Yang HK, Lee KU, Choe KJ. Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg 2005;92:1099-1102. https://doi.org/10.1002/bjs.4952

Cited by

  1. Totally Laparoscopic Surgery for Gastric Cancer vol.13, pp.1, 2013, https://doi.org/10.5230/jgc.2013.13.1.1
  2. Comparison of Short-Term Postoperative Outcomes in Totally Laparoscopic Distal Gastrectomy Versus Laparoscopy-Assisted Distal Gastrectomy vol.14, pp.2, 2013, https://doi.org/10.5230/jgc.2014.14.2.105
  3. Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience vol.17, pp.4, 2014, https://doi.org/10.1007/s10120-013-0327-x
  4. Systematic review and meta-analysis of totally laparoscopic versus laparoscopic assisted distal gastrectomy for gastric cancer vol.13, pp.None, 2015, https://doi.org/10.1186/s12957-015-0532-7
  5. Learning curve for hand-assisted laparoscopic D2 radical gastrectomy vol.21, pp.5, 2013, https://doi.org/10.3748/wjg.v21.i5.1606
  6. Development of a non-blurring, dual-imaging tissue marker for gastrointestinal tumor localization vol.29, pp.6, 2013, https://doi.org/10.1007/s00464-014-3822-1
  7. Comparison of short-term outcomes and acute inflammatory response between laparoscopy-assisted and totally laparoscopic distal gastrectomy for early gastric cancer vol.89, pp.4, 2013, https://doi.org/10.4174/astr.2015.89.4.176
  8. Surgical techniques, open versus minimally invasive gastrectomy after chemotherapy (STOMACH trial): study protocol for a randomized controlled trial vol.16, pp.1, 2013, https://doi.org/10.1186/s13063-015-0638-9
  9. The learning curve associated with laparoscopic total gastrectomy vol.19, pp.1, 2013, https://doi.org/10.1007/s10120-014-0447-y
  10. Comparison of laparoscopy-assisted and open radical gastrectomy for advanced gastric cancer : A retrospective study in a single minimally invasive surgery center vol.95, pp.25, 2013, https://doi.org/10.1097/md.0000000000003936
  11. Laparoscopic gastrectomy in obese gastric cancer patients: a comparative study with non-obese patients and evaluation of difference in laparoscopic methods vol.17, pp.None, 2013, https://doi.org/10.1186/s12876-017-0638-1
  12. Short-term outcomes in minimally invasive versus open gastrectomy: the differences between East and West. A systematic review of the literature vol.21, pp.1, 2013, https://doi.org/10.1007/s10120-017-0747-0
  13. A comparative study of totally laparoscopic distal gastrectomy versus laparoscopic-assisted distal gastrectomy in gastric cancer patients: Short-term operative outcomes at a high-volume center vol.30, pp.5, 2018, https://doi.org/10.21147/j.issn.1000-9604.2018.05.07
  14. Totally laparoscopic verse laparoscopic assisted distal gastrostomy for gastric cancer: an update meta-analysis vol.9, pp.15, 2013, https://doi.org/10.18632/oncotarget.23895
  15. Learning curve and short-term outcomes of modularized LADG for advanced gastric cancer : A retrospective study vol.98, pp.10, 2019, https://doi.org/10.1097/md.0000000000014670
  16. Laparoscopic gastrectomy using intracorporeally hand-sewn anastomosis of esophagojejunostomy, gastroduodenostomy, or gastrojejunostomy for gastric cancer vol.99, pp.5, 2013, https://doi.org/10.1097/md.0000000000019002
  17. Oncological Robot-Assisted Gastrectomy: Technical Aspects and Ongoing Data vol.30, pp.2, 2013, https://doi.org/10.1089/lap.2019.0345
  18. Efficacy of totally laparoscopic compared with laparoscopic-assisted total gastrectomy for gastric cancer: A meta-analysis vol.8, pp.5, 2013, https://doi.org/10.12998/wjcc.v8.i5.900
  19. Laparoscopic Versus Open D2 Gastrectomy for Gastric Cancer: A Case-Matched Comparative Study vol.30, pp.7, 2020, https://doi.org/10.1089/lap.2020.0023
  20. Laparoscopic versus open approach in gastrectomy for advanced gastric cancer: a systematic review vol.18, pp.None, 2013, https://doi.org/10.1186/s12957-020-01888-7
  21. Comparing the surgical outcomes of dual-port laparoscopic distal gastrectomy and three-port laparoscopic distal gastrectomy for gastric cancer vol.100, pp.1, 2021, https://doi.org/10.4174/astr.2021.100.1.18
  22. Establishment of a Fast-Track Gastrectomy Pathway for Patients With Gastric Adenocarcinoma at a U.S. Academic Cancer Center vol.268, pp.None, 2013, https://doi.org/10.1016/j.jss.2021.07.033