The Learning Curve for Hand-Assisted Laparoscopic Total Gastrectomy in Gastric Cancer Patients

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Hand-assisted laparoscopic total gastrectomy (LTG) is the standard surgical treatment for gastric cancer (GC) at the study center.
• Quantifying the learning curve for LTG is crucial for surgeon training and quality improvement.

Purpose of the Study:

• To determine the learning curve for surgeons performing LTG at a high-volume center.
• To assess the impact of surgical proficiency on patient outcomes.

Main Methods:

• Retrospective review of 118 consecutive LTG cases (2014-2020).
• Risk-adjusted cumulative sum (RA-CUSUM) analysis to define learning curve and proficiency groups.
• Comparison of surgical parameters, postoperative course, and survival outcomes between pre- and post-learning curve groups.

Main Results:

• The learning curve for LTG was completed at 44 cases.
• Post-learning curve LTG was associated with significantly shorter operating times (360 vs. 289 min) and a trend towards fewer major complications (26.67% vs. 13.70%).
• No significant differences were observed in anastomotic leakage, 30-day mortality, or 90-day mortality between groups.

Conclusions:

• Approximately 44 cases are needed for experienced surgeons to achieve technical competence in LTG.
• While operative efficiency improves post-learning curve, critical quality metrics like R0 resection, anastomotic leakage, and perioperative mortality are unaffected.
• Surgical proficiency level did not significantly impact overall survival (OS) or disease-free survival (DFS).