The Learning Curve for Hand-Assisted Laparoscopic Total Gastrectomy in Gastric Cancer Patients
(1) Background: Hand-assisted laparoscopic total gastrectomy (LTG) for patients with gastric cancer (GC) has been established as the standard surgical treatment at our center. This study aims to quantify the learning curve for surgeons performing minimally invasive total gastrectomy at a high-volume...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-11-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/11/22/6841 |
| _version_ | 1797464882596020224 |
|---|---|
| author | Philippa Seika Matthias Biebl Jonas Raakow Dino Kröll Candan Çetinkaya-Hosgör Peter Thuss-Patience Max Magnus Maurer Eva Maria Dobrindt Johann Pratschke Christian Denecke |
| author_facet | Philippa Seika Matthias Biebl Jonas Raakow Dino Kröll Candan Çetinkaya-Hosgör Peter Thuss-Patience Max Magnus Maurer Eva Maria Dobrindt Johann Pratschke Christian Denecke |
| author_sort | Philippa Seika |
| collection | DOAJ |
| description | (1) Background: Hand-assisted laparoscopic total gastrectomy (LTG) for patients with gastric cancer (GC) has been established as the standard surgical treatment at our center. This study aims to quantify the learning curve for surgeons performing minimally invasive total gastrectomy at a high-volume single center. (2) Methods: One hundred and eighteen consecutive patients who underwent minimally invasive total gastrectomy between January 2014 and December 2020 at a single high-volume center were included and reviewed retrospectively. Risk-adjusted cumulative sum analysis (RA-CUSUM) was used to monitor the surgical outcomes for patients with different risks of postoperative mortality using varying-coefficient logistic regression models. Patients were ordered by the sequential number of the procedure performed and divided into two groups according to the degree of surgeon proficiency as determined by RA-CUSUM analysis (group A: 45; group B: 73 patients). Age, gender, body mass index (BMI), tumor location, pathology, and comorbidities were compared while primary endpoints comprised surgical parameters, postoperative course, and survival outcomes. (3) Results: Forty-four cases were required for the completion of the learning curve. During this time, the mean operating time decreased. Hand-assisted laparoscopic total gastrectomy performed after a learning curve was associated with a shorter median operating time (OT) (360 min vs. 289 min, <0.001), and a reduced length of stay (A = 18.0 vs. B = 14.0 days) (<i>p</i> = 0.154), while there was a trend toward less major complications (Clavien–Dindo (CD) 3–5 within 90 days (12 (26.67%) vs. 10 (13.70%) <i>p</i> = 0.079). Our results showed no difference in anastomotic leakage between the two groups (group A vs. group B, 3 (6.67%) vs. 4 (5.48%) <i>p</i> = 0.99). Similarly, 30-day (0 (0%) vs. 1 (1.7%), <i>p</i> = 0.365) and 90-day mortality (1 (2.08%) vs. 2 (3.39%), <i>p</i> = 0.684) were comparable. Following multivariate analysis, the level of surgical proficiency was not a significant prognostic factor for overall survival. (4) Conclusions: A minimum of 44 cases are required for experienced laparoscopic surgeons to achieve technical competence for performing LTG. While operation time decreased after completion of the learning curve, quality criteria such as achievement of R0 resection, anastomotic leakage, and perioperative mortality remained unaltered. Of note, the level of surgical training showed no significant impact on the 2 year OS or DFS. |
| first_indexed | 2024-03-09T18:14:28Z |
| format | Article |
| id | doaj.art-2667f6aea5d0431690728c893a5b8fbf |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T18:14:28Z |
| publishDate | 2022-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-2667f6aea5d0431690728c893a5b8fbf2023-11-24T08:51:03ZengMDPI AGJournal of Clinical Medicine2077-03832022-11-011122684110.3390/jcm11226841The Learning Curve for Hand-Assisted Laparoscopic Total Gastrectomy in Gastric Cancer PatientsPhilippa Seika0Matthias Biebl1Jonas Raakow2Dino Kröll3Candan Çetinkaya-Hosgör4Peter Thuss-Patience5Max Magnus Maurer6Eva Maria Dobrindt7Johann Pratschke8Christian Denecke9Chirurgische Klinik, Campus Charité Mitte/Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, GermanyChirurgische Klinik, Campus Charité Mitte/Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, GermanyChirurgische Klinik, Campus Charité Mitte/Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, GermanyChirurgische Klinik, Campus Charité Mitte/Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, GermanyChirurgische Klinik, Campus Charité Mitte/Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, GermanyMedizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Campus Charité Mitte/Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, GermanyChirurgische Klinik, Campus Charité Mitte/Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, GermanyChirurgische Klinik, Campus Charité Mitte/Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, GermanyChirurgische Klinik, Campus Charité Mitte/Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, GermanyChirurgische Klinik, Campus Charité Mitte/Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany(1) Background: Hand-assisted laparoscopic total gastrectomy (LTG) for patients with gastric cancer (GC) has been established as the standard surgical treatment at our center. This study aims to quantify the learning curve for surgeons performing minimally invasive total gastrectomy at a high-volume single center. (2) Methods: One hundred and eighteen consecutive patients who underwent minimally invasive total gastrectomy between January 2014 and December 2020 at a single high-volume center were included and reviewed retrospectively. Risk-adjusted cumulative sum analysis (RA-CUSUM) was used to monitor the surgical outcomes for patients with different risks of postoperative mortality using varying-coefficient logistic regression models. Patients were ordered by the sequential number of the procedure performed and divided into two groups according to the degree of surgeon proficiency as determined by RA-CUSUM analysis (group A: 45; group B: 73 patients). Age, gender, body mass index (BMI), tumor location, pathology, and comorbidities were compared while primary endpoints comprised surgical parameters, postoperative course, and survival outcomes. (3) Results: Forty-four cases were required for the completion of the learning curve. During this time, the mean operating time decreased. Hand-assisted laparoscopic total gastrectomy performed after a learning curve was associated with a shorter median operating time (OT) (360 min vs. 289 min, <0.001), and a reduced length of stay (A = 18.0 vs. B = 14.0 days) (<i>p</i> = 0.154), while there was a trend toward less major complications (Clavien–Dindo (CD) 3–5 within 90 days (12 (26.67%) vs. 10 (13.70%) <i>p</i> = 0.079). Our results showed no difference in anastomotic leakage between the two groups (group A vs. group B, 3 (6.67%) vs. 4 (5.48%) <i>p</i> = 0.99). Similarly, 30-day (0 (0%) vs. 1 (1.7%), <i>p</i> = 0.365) and 90-day mortality (1 (2.08%) vs. 2 (3.39%), <i>p</i> = 0.684) were comparable. Following multivariate analysis, the level of surgical proficiency was not a significant prognostic factor for overall survival. (4) Conclusions: A minimum of 44 cases are required for experienced laparoscopic surgeons to achieve technical competence for performing LTG. While operation time decreased after completion of the learning curve, quality criteria such as achievement of R0 resection, anastomotic leakage, and perioperative mortality remained unaltered. Of note, the level of surgical training showed no significant impact on the 2 year OS or DFS.https://www.mdpi.com/2077-0383/11/22/6841gastric surgerylearning curveCUSUMminimally invasive gastrectomygastric cancer |
| spellingShingle | Philippa Seika Matthias Biebl Jonas Raakow Dino Kröll Candan Çetinkaya-Hosgör Peter Thuss-Patience Max Magnus Maurer Eva Maria Dobrindt Johann Pratschke Christian Denecke The Learning Curve for Hand-Assisted Laparoscopic Total Gastrectomy in Gastric Cancer Patients Journal of Clinical Medicine gastric surgery learning curve CUSUM minimally invasive gastrectomy gastric cancer |
| title | The Learning Curve for Hand-Assisted Laparoscopic Total Gastrectomy in Gastric Cancer Patients |
| title_full | The Learning Curve for Hand-Assisted Laparoscopic Total Gastrectomy in Gastric Cancer Patients |
| title_fullStr | The Learning Curve for Hand-Assisted Laparoscopic Total Gastrectomy in Gastric Cancer Patients |
| title_full_unstemmed | The Learning Curve for Hand-Assisted Laparoscopic Total Gastrectomy in Gastric Cancer Patients |
| title_short | The Learning Curve for Hand-Assisted Laparoscopic Total Gastrectomy in Gastric Cancer Patients |
| title_sort | learning curve for hand assisted laparoscopic total gastrectomy in gastric cancer patients |
| topic | gastric surgery learning curve CUSUM minimally invasive gastrectomy gastric cancer |
| url | https://www.mdpi.com/2077-0383/11/22/6841 |
| work_keys_str_mv | AT philippaseika thelearningcurveforhandassistedlaparoscopictotalgastrectomyingastriccancerpatients AT matthiasbiebl thelearningcurveforhandassistedlaparoscopictotalgastrectomyingastriccancerpatients AT jonasraakow thelearningcurveforhandassistedlaparoscopictotalgastrectomyingastriccancerpatients AT dinokroll thelearningcurveforhandassistedlaparoscopictotalgastrectomyingastriccancerpatients AT candancetinkayahosgor thelearningcurveforhandassistedlaparoscopictotalgastrectomyingastriccancerpatients AT peterthusspatience thelearningcurveforhandassistedlaparoscopictotalgastrectomyingastriccancerpatients AT maxmagnusmaurer thelearningcurveforhandassistedlaparoscopictotalgastrectomyingastriccancerpatients AT evamariadobrindt thelearningcurveforhandassistedlaparoscopictotalgastrectomyingastriccancerpatients AT johannpratschke thelearningcurveforhandassistedlaparoscopictotalgastrectomyingastriccancerpatients AT christiandenecke thelearningcurveforhandassistedlaparoscopictotalgastrectomyingastriccancerpatients AT philippaseika learningcurveforhandassistedlaparoscopictotalgastrectomyingastriccancerpatients AT matthiasbiebl learningcurveforhandassistedlaparoscopictotalgastrectomyingastriccancerpatients AT jonasraakow learningcurveforhandassistedlaparoscopictotalgastrectomyingastriccancerpatients AT dinokroll learningcurveforhandassistedlaparoscopictotalgastrectomyingastriccancerpatients AT candancetinkayahosgor learningcurveforhandassistedlaparoscopictotalgastrectomyingastriccancerpatients AT peterthusspatience learningcurveforhandassistedlaparoscopictotalgastrectomyingastriccancerpatients AT maxmagnusmaurer learningcurveforhandassistedlaparoscopictotalgastrectomyingastriccancerpatients AT evamariadobrindt learningcurveforhandassistedlaparoscopictotalgastrectomyingastriccancerpatients AT johannpratschke learningcurveforhandassistedlaparoscopictotalgastrectomyingastriccancerpatients AT christiandenecke learningcurveforhandassistedlaparoscopictotalgastrectomyingastriccancerpatients |