Hu Wei-guo, Ma Jun-Jun, Zang Lu, Xue Pei, Xu Hua, Wang Ming-Liang, Lu Ai-Guo, Li Jian-Wen, Feng Bo, Zheng Min-Hua
Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai, China; Shanghai Minimally Invasive Surgery Center , Shanghai, China .
J Laparoendosc Adv Surg Tech A. 2014 Jul;24(7):487-92. doi: 10.1089/lap.2013.0570. Epub 2014 Jun 16.
To discuss the learning curve of laparoscopy-assisted distal gastrectomy (LADG) with lymph node dissection and the oncological results and long-term outcomes of different periods in the learning stage.
One hundred twenty-four patients with gastric cancer who received LADG with lymph node dissection from January 2004 to December 2009 were retrospectively reviewed and analyzed. They were divided into three groups (A-C) according to different operative date: 41 were in Group A (early), 41 in Group B (middle), and 42 in Group C (laer). There were no significant statistical differences among the three groups with respect to age, gender, early/advanced gastric cancer, Union for International Cancer Control stage, and lymph node dissection. Then the following items were compared in these groups: operative time, blood loss, number of lymph nodes harvested, postoperative complications, postoperative hospital stay, and long-term survival.
The operative time in Group A (235.0±50.3 minutes) was significantly longer than in Groups B (201.7±39.6 minutes) and C (199.0±44.7 minutes), but there was no significant difference between Groups B and C. The harvest of lymph nodes from Group A (11.0±5.5) was significantly less than from Groups B (16.3±9.2) and C (17.2±8.7), but there was no significant difference between Groups B and C. The postoperative hospital stay and complications, overall survival, and disease-free survival showed no difference among the three groups.
The learning curve of gastrointestinal surgeons with experience of laparoscopic operation is about 40 cases. The oncological principles and long-term outcomes were not sacrificed during the learning stage.
探讨腹腔镜辅助远端胃癌根治术（LADG）联合淋巴结清扫的学习曲线，以及学习阶段不同时期的肿瘤学结果和长期预后。
回顾性分析2004年1月至2009年12月期间接受LADG联合淋巴结清扫的124例胃癌患者。根据手术日期将他们分为三组（A - C）：A组（早期）41例，B组（中期）41例，C组（后期）42例。三组在年龄、性别、早期/进展期胃癌、国际癌症控制联盟分期和淋巴结清扫方面无显著统计学差异。然后比较这些组的以下项目：手术时间、失血量、清扫淋巴结数量、术后并发症、术后住院时间和长期生存率。
A组的手术时间（235.0±50.3分钟）显著长于B组（201.7±39.6分钟）和C组（199.0±44.7分钟），但B组和C组之间无显著差异。A组清扫的淋巴结数量（11.0±5.5）显著少于B组（16.3±9.2）和C组（17.2±8.7），但B组和C组之间无显著差异。三组的术后住院时间、并发症、总生存率和无病生存率无差异。
有腹腔镜手术经验的胃肠外科医生的学习曲线约为40例。在学习阶段未牺牲肿瘤学原则和长期预后。
