Learning curve for gastric cancer surgery based on actual survival

The aim of this study was to investigate learning curves for surgeons performing D2 lymph node dissection based on actual patient survival.

A total of 3,284 patients with gastric cancer who underwent curative intent gastric cancer surgery by nine surgeons in eight Korean hospitals between 2001 and 2006 were included. Each surgeon's experience was coded as the number of D1 + β or more gastrectomies performed before that for each patient, which indicates the surgeon's total number of prior surgical experiences. Surgeon experience was grouped into two sets of categories. The set of categories included four groups of experience: ≤50, 51-100, 101-200, and >200 applicable operations. Multivariate survival time regression models were used to evaluate the association between surgeon experience and overall survival.

The learning curve for gastric cancer survival after open gastric cancer surgery was steep and did not reach a plateau until a surgeon completed 100 operations. Overall survival rate was the lowest among patients treated by a surgeon with an experience of 50-100 cases. The overall survival of patients at 5 years when the surgeon had a history of more than 100 experiences was higher in each stage than that when the surgeon had a history of fewer than 100 experiences.

As a surgeon's experience increases, survival after gastric cancer surgery improves. Special attention needs to be paid to the second period of surgeon experience because survival of patients in this period was the lowest.