조기위암에 시행된 복강경 보조 원위부 위절제술의 학습곡선 극복 시점 및 극복 전후의 비교

Abstract

Purpose: Laparoscopic assisted distal gastrectomy (LADG) has been increasingly used for the treatment of early gastric cancer. However, there have been few studies on the learning curve (LC) for this procedure. The aim of this study was to determine the time needed to overcome the LC of LADG and to document the surgical and clinical differences. Methods: This study retrospectively reviewed 202 LADGs performed by a single surgeon. The time required to overcome the LC was determined by examining the operation times. The surgical results, preoperative and postoperative clinicopathology data between before and after overcoming the LC were compared. In addition, the point of overcoming the LC was determined according to the occurrence of major complications. Results: The 63rd case was identified as the point when the LC had been overcome according to the operation time, and the differences between before and after overcoming the LC with regard to the operative time (250 vs 156 minutes), transfusion rate (30 vs 2.8%), proximal and distal safety margin from the lesion (4.3 vs 5.9 and 4.3 vs 6.9 cm), the total number of dissected lymph nodes (20.6 vs 34.2), white blood cell count checked at the postoperative 2nd day (12,377 vs 9,567/mm3), hospital stay (10.8 vs 7.9 days) and the rate of major complications (6 vs 1%) were all significant (all P＜0.05). The point when the LC was overcome according to the occurrence of major complications occurred at the 50th case. Conclusion: Overcoming the LC of LADG has benefits in terms of the patientꡑs safety and surgeonꡑs stress. (J Korean Surg Soc 2006;70:370-374)