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J Surg Oncol. 2014 Dec;110(8):989-96. doi: 10.1002/jso.23757. Epub 2014 Oct 7.

Learning curve of laparoscopic low anterior resection in terms of local recurrence.

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Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Republic of Korea.



Experience in terms of surgical case numbers required to develop proficiency for oncologic adequacy after sphincter-saving laparoscopic rectal cancer surgery has not been established.


Three hundred seventeen consecutive patients underwent sphincter-saving laparoscopic rectal cancer surgery with curative intent performed by single surgeon. The learning curve was estimated using risk-adjusted cumulative sum (RA-CUSUM) and the graph of 195 consecutive patients who were treated by another surgeon was used to evaluate inter-surgeon variability in the learning curve.


Overall, the 3-year local recurrence rate was 7.7% (95% confidence interval [CI], 6.4%-9.0%). The RA-CUSUM analysis demonstrated a learning curve of 110 cases for local recurrence for both of surgeons and 50-70 cases for CRM involvement. The 3-year local recurrence-free rate was better during the experienced period than during the learning period (95.1% [95% CI, 91.6%-97.1%] vs. 89.5% [95% CI, 84.4%-93.0%]; P = 0.029). These differences were obvious in subgroup analysis of stage III tumors (93.4% [95% CI, 86.6%-96.8%] vs. 78.6% [95% CI, 68.5%-85.3%]; P = 0.013).


Local recurrence rates decreased with increasing surgeon experience, as did other short-term outcomes, especially in advanced disease cases.


laparoscopy; learning curve; local; neoplasm recurrence; rectal cancer

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