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Gastric Cancer. 2019 Mar 4. doi: 10.1007/s10120-019-00948-6. [Epub ahead of print]

Operation time as a simple indicator to predict the overcoming of the learning curve in gastric cancer surgery: a multicenter cohort study.

Author information

1
Department of Surgery and Cancer Research Institute, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu 110-744, Seoul, South Korea.
2
Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, South Korea.
3
Gastric Cancer Center, National Cancer Center, Goyang, South Korea.
4
Department of Surgery, Samsung Medical Center, Seoul, South Korea.
5
Department of Surgery, Soon Chun Hyang University Bucheon Hospital, Bucheon, South Korea.
6
Department of Surgery, Yonsei University Severance Hospital, Seoul, South Korea.
7
Department of Surgery, Chonbuk National University Hospital, Jeonju, South Korea.
8
Department of Surgery, Dong-A University Hospital, Busan, South Korea.
9
Department of Surgery, Keimyung University Dongsan Hospital, Daegu, South Korea.
10
Department of Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea.
11
Department of Surgery and Cancer Research Institute, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu 110-744, Seoul, South Korea. appe98@snu.ac.kr.
12
Cancer Research Institute, Seoul National University, Seoul, South Korea. appe98@snu.ac.kr.

Abstract

BACKGROUND:

The aim of this study is to identify an indicator to predict the overcoming of the learning curve of distal gastrectomy in gastric cancer surgery.

METHOD:

A retrospective multicenter cohort study was conducted in 2100 patients who underwent radical distal gastrectomy performed by nine surgeons in eight hospitals between 2001 and 2006. For each surgeon, an individual CUSUM chart was formulated in terms of operation time or clinical outcomes, including severe complications, number of retrieved lymph nodes, positive resection margin, and hospital stay. The actual changing points (CPs) of the CUSUM charts were analyzed. Based on the CP, patients were divided into pre-CP and post-CP groups, and the clinicopathologic outcomes and survival data were compared between the groups.

RESULTS:

CP determined by operation time was more reliable than CP determined by a combination of clinical outcomes, as the former was correlated not only with short-term outcomes but also with survival. The outcomes were superior in the post-CP group in terms of numbers of harvested lymph nodes, sufficient lymph node harvesting (> 15), and negative proximal margins. In a survival analysis, the post-CP group showed better survival than the pre-CP group in stage II (76% vs 86.1% p = 0.010) and stage III (51.5% vs 60.6% p = 0.042).

CONCLUSION:

Overcoming the learning curve of distal gastrectomy for gastric cancer can be better predicted by operation time rather than by a combination of postoperative clinical parameters. It is recommended that surgeons initially operate on early stage cancer patients before overcoming the learning curve.

KEYWORDS:

Cancer; Gastrectomy; Learning

PMID:
30830639
DOI:
10.1007/s10120-019-00948-6

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