Choi Dong Hyun, Jeong Woon Kyung, Lim Sang-Woo, Chung Tae Sung, Park Jung-In, Lim Seok-Byung, Choi Hyo Seong, Nam Byung-Ho, Chang Hee Jin, Jeong Seung-Yong
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Ilsandong-gu, Goyang, Gyeonggi, Korea.
Surg Endosc. 2009 Mar;23(3):622-8. doi: 10.1007/s00464-008-9753-y. Epub 2008 Feb 13.
Laparoscopic surgery demands mastery of a steep learning curve. Defining a learning curve in laparoscopic surgery is useful for planning training programs or clinical trials. This study aimed to define the learning curves for laparoscopic sigmoidectomy used to manage curable sigmoid colon cancer by evaluating early surgical outcome data from three colorectal surgeons.
This study analyzed data from 138 consecutive patients undergoing laparoscopic sigmoidectomy for curable sigmoid colon cancer performed by three colorectal surgeons between May 2001 and November 2006. The learning curve for each surgeon were generated using the moving average method to assess changes in operation time and cumulative sum (CUSUM) analysis to assess changes in failure rates [(failure = conversion to open surgery, major perioperative complication, or failure to harvest an adequate number of lymph nodes (<12 nodes)].
Learning curves generated with the moving average method indicated that the operation time reached a steady state after 42 cases for surgeon A, 35 cases for surgeon B, and 30 cases for surgeon C. The overall open conversion rate was 2.9%. There was only one laparoscopy-related perioperative major complication (0.7%). An inadequate number of lymph nodes was harvested in 10 cases (7.2%): 6 (10.5%) for surgeon A, 1 (2.4%) for surgeon B, and 3 (7.7%) for surgeon C. Learning curves generated using CUSUM analysis based on a 90% success rate showed that adequate learning occurred after 10 cases for surgeon A, 17 cases for surgeon B, and 5 cases for surgeon C.
Pertinent learning curves for laparoscopic sigmoidectomy used to manage curable sigmoid colon cancer can be generated using the moving average method and CUSUM analysis. These results are likely to be useful in designing laparoscopic training programs and clinical trials aimed at investigating outcomes of laparoscopic colorectal cancer surgery.
腹腔镜手术需要掌握陡峭的学习曲线。确定腹腔镜手术的学习曲线对于规划培训项目或临床试验很有用。本研究旨在通过评估三位结直肠外科医生的早期手术结果数据，确定用于治疗可治愈性乙状结肠癌的腹腔镜乙状结肠切除术的学习曲线。
本研究分析了2001年5月至2006年11月期间三位结直肠外科医生为138例可治愈性乙状结肠癌患者进行腹腔镜乙状结肠切除术的连续数据。使用移动平均法生成每位外科医生的学习曲线，以评估手术时间的变化，并使用累积和（CUSUM）分析来评估失败率的变化[（失败=转为开放手术、围手术期重大并发症或未能获取足够数量的淋巴结（<12个淋巴结）]。
移动平均法生成的学习曲线表明，A医生在42例手术后手术时间达到稳定状态，B医生在35例后，C医生在30例后。总体开放转换率为2.9%。只有1例与腹腔镜相关的围手术期重大并发症（0.7%）。10例（7.2%）患者获取的淋巴结数量不足：A医生6例（10.5%），B医生1例（2.4%），C医生3例（7.7%）。基于90%成功率的CUSUM分析生成的学习曲线表明，A医生在10例手术后充分学习，B医生在17例后，C医生在5例后。
使用移动平均法和CUSUM分析可以生成用于治疗可治愈性乙状结肠癌的腹腔镜乙状结肠切除术的相关学习曲线。这些结果可能有助于设计腹腔镜培训项目和旨在研究腹腔镜结直肠癌手术结果的临床试验。
