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Learning curve for total gastrectomy with D2 lymph node dissection: cumulative sum analysis for qualified surgery.
Jun Ho Lee1, Keun Won Ryu, Jin-Hee Lee
1Center for Gastric Cancer, National Cancer Center, 809 Madul-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do 411-769, South Korea.
Annals of Surgical Oncology
|September 2, 2006
Summary
The surgical learning curve for D2 lymph node dissection in gastric cancer patients requires approximately 23 cases or 8 months for surgeons to achieve proficiency, impacting clinical trial design.
Area of Science:
- Surgical Oncology
- Gastrointestinal Surgery
Background:
- Evaluating the learning curve for D2 lymph node dissection in gastric cancer surgery.
- High-volume center data was utilized for this prospective study.
Purpose of the Study:
- To assess the learning curve associated with D2 lymph node dissection in gastric cancer patients.
- Determine the number of cases required for surgeons to achieve proficiency.
Main Methods:
- Prospective review of total gastrectomy with D2 lymph node dissection cases over 4 years.
- Used retrieved lymph node count (>25) as a surrogate for oncological outcome.
- Applied cumulative sum analysis to evaluate surgeon learning curves at various accuracy targets.
Main Results:
- Two junior surgeons performed 198 dissections with >90% success rates.
- Operating time significantly decreased with experience (r=-0.515, P<0.001).
- Learning period estimated at 23-35 cases for a 92.5% success rate.
Conclusions:
- The learning period for D2 lymph node dissection is at least 23 cases or 8 months.
- Surgeon learning curves are crucial for minimizing bias in gastric cancer clinical trials.
- Consideration of surgical proficiency is vital for reliable oncological outcomes.