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Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer

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Abstract

Background

Laparoscopy-assisted gastrectomy (LAG) is a complex and time-consuming procedure, which is increasingly used for early gastric cancer (EGC). We provide a multidimensional analysis of the learning curve in LAG.

Methods

Cumulative sum method was used to analyze outcomes of 109 patients undergoing LAG for EGC by one surgeon over a two year period; the influence of patient selection was evaluated. Target failure rate was set at 10%, with failure defined as open conversion, mortality, major morbidity, residual tumor, or inappropriate lymphadenectomy.

Results

There were 19 failures-fourteen performance and five oncologic. The learning curve, which displayed a slight rising trend and three phases was achieved after 40 cases with selected patients; it was broken, however, by the introduction of advanced procedures and unselected patients.

Conclusions

Advanced procedures and broad indications in LAG should be delayed until a learning curve is completed under the target failure rate.

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Authors and Affiliations

  1. Department of Surgery, School of Medicine, Ajou University, San-5, Wonchon-Dong, Yeongtong-Gu, Suwon, 442-749, Korea

    Sung-Ho Jin, Do-Yoon Kim, Hong Kim, In Ho Jeong, Myung-Wook Kim, Yong Kwan Cho & Sang-Uk Han

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  1. Sung-Ho Jin
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  2. Do-Yoon Kim
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  3. Hong Kim
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  4. In Ho Jeong
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  5. Myung-Wook Kim
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  6. Yong Kwan Cho
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  7. Sang-Uk Han
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Corresponding author

Correspondence to Sang-Uk Han.

Appendix

Appendix

Calculation of CUSUM Boundary Lines [9, 14, 19]

  • p0 = target failure rate = 0.10

  • p1 = alternative failure rate at which one wishes to be alerted if failure rate rose to this level = 0.20

  • α = type I (false alarm) error rate — probability of incorrectly rejecting the target p0 in favor of the alternative p1 (0.05 for 95% “alarm” line, 0.20 for 80% “alert” line).

  • β = type II (false reassurance) error rate — probability of incorrectly rejecting the alternative p1 in favor of the target p0 = 0.20.

  • a = ln([1 − β]/α)

  • b = ln([1 − α]/β)

  • P = ln(p1/p0)

  • Q = ln([1 − p0)/(1 − p1])

  • s = Q/(P + Q)

  • n = number of operations (horizontal axis)

  • X = accumulated number of failures after n operations (vertical axis)

  • Lower (“reassurance”) boundary line: X0 = ns − b/(P + Q)

  • Upper (“alert” or “alarm”) boundary line: X1 = ns − a/(P + Q)

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Jin, SH., Kim, DY., Kim, H. et al. Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer. Surg Endosc 21, 28–33 (2007). https://doi.org/10.1007/s00464-005-0634-3

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  • DOI: https://doi.org/10.1007/s00464-005-0634-3

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