Learning curve for laparoscopic D2 gastrectomy in a Western population: safety and oncologic analysis of a bariatric...

Laparoscopic gastrectomy is increasingly adopted worldwide, but data in Western populations remain scarce. Bariatric experience may ease its implementation, yet oncologic safety requires validation.

We retrospectively analyzed 113 consecutive laparoscopic D2 gastrectomies (2019-2024) performed by a bariatric-experienced team at a tertiary center. Patient demographics, surgical outcomes, and oncologic variables were collected. Textbook outcome, operative time, complications, hospital stay, and lymph node yield were assessed. Learning curves were evaluated using Moving Average and CUSUM analyses.

A total of 113 laparoscopic D2 gastrectomies were performed (60 total, 53 subtotal). Textbook outcome was achieved in 68% overall, increasing to 83% in the final group (p = 0.21). Mean operative time decreased significantly from 333 min in the first group to 263-272 min after 45 cases (p = 0.001). Lymph node yield improved from 20.1 to > 37 nodes after 32 cases (p = 0.001). Hospital stay remained stable across groups (median 4-6 days, p = 0.92). Major complications decreased from 30.4 to 12.5% without statistical significance (p = 0.66). According to learning curve assessment, textbook outcome plateaued after 71 cases (Cusum (C)), surgical time plateaued after 45 (Moving Average (MA))/29 (C), complications and hospital stay after 53 (C), and lymph node yield after 23 (MA)/32 (C).

Laparoscopic D2 gastrectomy is feasible and safe in Western centers with bariatric surgery expertise, but approximately 70 cases are required to achieve optimal textbook outcomes. Structured training and high-volume practice are essential to ensure oncologic and surgical quality.