[Learning curve of laparoscopic D2 gastrectomy for gastric cancer]

To analyze the learning curve for an experienced laparoscopic colorectal surgeon in performing to laparoscopic D2 gastrectomy for gastric cancer.

From July 2004 to July 2009, 70 patients undergoing laparoscopic D2 gastrectomy performed by a single surgical team were retrospectively evaluated. The patients were divided into groups A to G (n=10) based on the surgery date, and the operation time, estimated blood loss (EBL), conversion to open surgery, number of lymph nodes harvested, complications, and recovery indicators were compared.

No statistical differences were found among the groups in age, gender, gastrectomy approach, EBL, number of lymph nodes harvested, time to flatus, or postoperative hospital stay (P>0.05). No significant differences were found in the operation time between groups A and B (P=0.999) or among the other 5 groups (P>0.05), but the operation time in groups A (300.00-/+104.59 min) and B (261.00-/+40.50 min) were significantly longer than that in the other 5 groups (C: 191.30-/+23.11 min, D: 188.60-/+31.38 min, E: 181.10-/+20.18 min, F: 167.50-/+32.81 min, and G: 161.30-/+29.03 min). Compared with that in group A, the time to liquid diet decreased significantly in the remaining 6 groups (P<0.05). Conversion to open surgery occurred in two cases (2.86%, both in group B), 2 patients in group B and another 2 in group C developed intraoperative complications, and one in group C had postoperative complication, with the total incidence of complication of 7.14% in this series.

A well-trained laparoscopic colorectal surgeon, by following the standard surgical procedures, are likely to overcome the learning curve smoothly after performing approximately 20 cases of laparoscopic D2 gastrectomy for gastric cancer.