TY - JOUR
T1 - Learning Curve of Laparoscopic Gastrectomy
T2 - A Multicenter Study
AU - Brenkman, Hylke J F
AU - Claassen, Linda
AU - Hannink, Gerjon
AU - van der Werf, Leonie R
AU - Ruurda, Jelle P-H
AU - Nieuwenhuizen, Grard A P
AU - Luyer, Misha D P
AU - Kouwenhoven, Ewout A
AU - van Det, Marc J
AU - van Berge Henegouwen, Mark I
AU - Gisbertz, Suzanne S
AU - Stoot, Jan H M B
AU - Hulsewé, Karel W E
AU - van Workum, Frans
AU - van Hillegersberg, Richard
AU - Rosman, Camiel
N1 - Funding Information:
M.I.v.B.H. is consultant for Mylan, Johnson & Johnson, Alesi Surgical, BBraun and Medtronic, and received unrestricted research grants from Olympus and Stryker (all fees paid to institution). J.H.M.B.S. has served as faculty in an online training course for inguinal hernia repair from Medtronic. M.D.P.L. has a consulting and advisory role at Galvani and Medtronic, and received research funding from the Dutch Cancer Foundation. G.A.P.N. has received research funding from Medtronic. J.P.H.R. and R.v.H. have a consulting and advisory role at Intuitive Surgical. The remaining authors report no conflicts of interest.
Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/4/1
Y1 - 2023/4/1
N2 - OBJECTIVE: To evaluate the learning curve of laparoscopic gastrectomy (LG) after an implementation program.BACKGROUND: Although LG is increasingly being performed worldwide, little is known about the learning curve.METHODS: Consecutive patients who underwent elective LG for gastric adenocarcinoma with curative intent in each of the 5 highest-volume centers in the Netherlands were enrolled. Generalized additive models and a 2-piece model with a break point were used to determine the learning curve length. Analyses were corrected for casemix and were performed for LG and for the subgroups distal gastrectomy (LDG) and total gastrectomy (LTG). The learning curve effect was assessed for (1) anastomotic leakage; and (2) the occurrence of postoperative complications, conversions to open surgery, and short-term oncological parameters.RESULTS: In total 540 patients were included for analysis, 108 patients from each center; 268 patients underwent LDG and 272 underwent LTG. First, for LG, no learning effect regarding anastomotic leakage could be identified: the rate of anastomotic leakage initially increased, then reached a plateau after 36 cases at 10% anastomotic leakage. Second, the level of overall complications reached a plateau after 20 cases, at 38% overall complications, and at 5% conversions. For both LDG and LTG, each considered separately, fluctuations in secondary outcomes and anastomotic leakage followed fluctuations in casemix.CONCLUSION: On the basis of our study of the first 108 procedures of LG in 5 high-volume centers with well-trained surgeons, no learning curve effect could be identified regarding anastomotic leakage. A learning curve effect was found with respect to overall complications and conversion rate.
AB - OBJECTIVE: To evaluate the learning curve of laparoscopic gastrectomy (LG) after an implementation program.BACKGROUND: Although LG is increasingly being performed worldwide, little is known about the learning curve.METHODS: Consecutive patients who underwent elective LG for gastric adenocarcinoma with curative intent in each of the 5 highest-volume centers in the Netherlands were enrolled. Generalized additive models and a 2-piece model with a break point were used to determine the learning curve length. Analyses were corrected for casemix and were performed for LG and for the subgroups distal gastrectomy (LDG) and total gastrectomy (LTG). The learning curve effect was assessed for (1) anastomotic leakage; and (2) the occurrence of postoperative complications, conversions to open surgery, and short-term oncological parameters.RESULTS: In total 540 patients were included for analysis, 108 patients from each center; 268 patients underwent LDG and 272 underwent LTG. First, for LG, no learning effect regarding anastomotic leakage could be identified: the rate of anastomotic leakage initially increased, then reached a plateau after 36 cases at 10% anastomotic leakage. Second, the level of overall complications reached a plateau after 20 cases, at 38% overall complications, and at 5% conversions. For both LDG and LTG, each considered separately, fluctuations in secondary outcomes and anastomotic leakage followed fluctuations in casemix.CONCLUSION: On the basis of our study of the first 108 procedures of LG in 5 high-volume centers with well-trained surgeons, no learning curve effect could be identified regarding anastomotic leakage. A learning curve effect was found with respect to overall complications and conversion rate.
KW - gastrectomy
KW - laparoscopy
KW - learning curve
UR - http://www.scopus.com/inward/record.url?scp=85149864620&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000005479
DO - 10.1097/SLA.0000000000005479
M3 - Article
C2 - 35801714
SN - 0003-4932
VL - 277
SP - e808-e816
JO - Annals of surgery
JF - Annals of surgery
IS - 4
ER -