BACKGROUND: This study aimed to assess the learning curve in laparoscopic right hemicolectomy and compare the long-term oncologic outcomes of the learning curve period. MATERIALS AND METHODS: We retrospectively reviewed 97 patients who underwent a laparoscopic right hemicolectomy by a single surgeon between July 2006 and January 2009. Among them, 87 patients, excluding patients with stage IV (n=10) disease, were evaluated for long-term oncologic outcomes. They were divided into 2 phases: phase 1 (the learning curve period) and phase 2 (the expert period). The cumulative sum method was used for estimating the learning curve. RESULTS: The learning curve was determined at the 42nd case. Patient characteristics and postoperative clinicopathologic outcomes were similar in both groups except for the operation time (212.5±65.0 min vs. 146.4±37.1 min; P<0.001) and length of stay (10.7±5.4 d vs. 8.4±2.9 d; P=0.015). The 5-year overall survival rates were similar in both groups throughout all stages. The 5-year disease-free survival rate of stage III disease in phase 2 (85%) was better than that of phase 1 (53.3%; P=0.046). CONCLUSIONS: Laparoscopic right hemicolectomy during the learning curve period showed acceptable clinicopathologic outcomes. However, the 5-year disease-free survival rate was compromised in patients with stage III disease in phase I.
BACKGROUND: This study aimed to assess the learning curve in laparoscopic right hemicolectomy and compare the long-term oncologic outcomes of the learning curve period. MATERIALS AND METHODS: We retrospectively reviewed 97 patients who underwent a laparoscopic right hemicolectomy by a single surgeon between July 2006 and January 2009. Among them, 87 patients, excluding patients with stage IV (n=10) disease, were evaluated for long-term oncologic outcomes. They were divided into 2 phases: phase 1 (the learning curve period) and phase 2 (the expert period). The cumulative sum method was used for estimating the learning curve. RESULTS: The learning curve was determined at the 42nd case. Patient characteristics and postoperative clinicopathologic outcomes were similar in both groups except for the operation time (212.5±65.0 min vs. 146.4±37.1 min; P<0.001) and length of stay (10.7±5.4 d vs. 8.4±2.9 d; P=0.015). The 5-year overall survival rates were similar in both groups throughout all stages. The 5-year disease-free survival rate of stage III disease in phase 2 (85%) was better than that of phase 1 (53.3%; P=0.046). CONCLUSIONS: Laparoscopic right hemicolectomy during the learning curve period showed acceptable clinicopathologic outcomes. However, the 5-year disease-free survival rate was compromised in patients with stage III disease in phase I.
Authors: Lawrence Lee; Nathalie Wong-Chong; Justin J Kelly; George J Nassif; Matthew R Albert; John R T Monson Journal: Surg Endosc Date: 2018-07-02 Impact factor: 4.584