Department of General Surgery, Centre for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China.
Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
Br J Surg. 2021 Sep 27;108(9):1126-1132. doi: 10.1093/bjs/znab152.
This study aims to assess the learning curve of robotic distal gastrectomy (RDG) and robotic total gastrectomy (RTG) for gastric cancer.
Data on consecutive patients who underwent robotic gastrectomy for gastric cancer by five surgeons between March 2010 and August 2019 at two high-volume institutions were collected. The learning curve was determined based on the analyses of operation time and postoperative complications within 30 days. Cumulative sum analysis (CUSUM) and risk-adjusted-CUSUM (RA-CUSUM) were applied to identify the turning points (TPs).
A total of 899 consecutive patients were included. The mean number of patients needed to overcome the learning curve for operation time of RDG and RTG were 22 and 20, respectively. The number of patients needed to overcome the learning curve for postoperative complications after RDG and RTG were 23 and 18, respectively. The surgical outcomes in the post-TP group were better than in the pre-TP group and improved as surgeons' experience increased. Also, increased case numbers in RDG promoted the RTG learning process.
The present study demonstrated a substantial influence of surgical cumulative volume on improved surgical outcomes in robotic gastrectomy. Increased experience in RDG may help surgeons to achieve proficiency faster in RTG.
本研究旨在评估机器人辅助远端胃切除术（RDG）和机器人辅助全胃切除术（RTG）治疗胃癌的学习曲线。
收集了 2010 年 3 月至 2019 年 8 月期间，在两个高容量机构，由五位外科医生为胃癌患者实施机器人胃切除术的连续患者数据。基于手术时间和术后 30 天内并发症的分析，确定学习曲线。应用累积和分析（CUSUM）和风险调整累积和分析（RA-CUSUM）来确定转折点（TPs）。
共纳入 899 例连续患者。克服 RDG 和 RTG 手术时间学习曲线所需的平均患者人数分别为 22 和 20。克服 RDG 和 RTG 术后并发症学习曲线所需的患者人数分别为 23 和 18。TP 后的手术结果优于 TP 前，且随着外科医生经验的增加而改善。此外，RDG 病例数量的增加促进了 RTG 的学习过程。
本研究表明，手术累积量对机器人胃切除术中手术结果的改善有实质性影响。RDG 经验的增加可能有助于外科医生更快地掌握 RTG。
