The Learning Curve of Linear-Shaped Gastroduodenostomy Associated with Totally Laparoscopic Distal Gastrectomy.
Gastric cancer
Gastroduodenostomy
Learning curve
Minimally invasive surgery
Reconstruction
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
11
03
2019
accepted:
09
07
2019
pubmed:
22
7
2019
medline:
15
4
2021
entrez:
21
7
2019
Statut:
ppublish
Résumé
Linear-shaped gastroduodenostomy (LSGD) is a new method of intracorporeal reconstruction that is simpler to perform and associated with a lower rate of bile reflux than delta-shaped anastomosis. Here, we analyzed the learning curve of LSGD in totally laparoscopic distal gastrectomy. The cumulative sum method was used to retrospectively analyze consecutive gastric cancer patients undergoing intracorporeal gastroduodenostomy after distal gastrectomy between January 2009 and May 2016. The duration of surgery, postoperative complications, hospital stay, and endoscopic findings in the postoperative period and the first, third, and fifth year were evaluated according to the two phases of the learning curve (learning period versus mastery period). Data from 222 patients were included in the analysis. The LSGD learning period was 29 cases. The surgical time in mastery period was significantly shorter than the learning period (124.9 ± 34.5 versus 168.2 ± 42.0 min, p < 0.001). The incidence of minor complications was significantly reduced after the learning period (p = 0.041), although there was no statistically significant difference in the rate of major complications. The long-term endoscopic findings showed that the presence of residual food decreased over the time (p = 0.022). LSGD can be mastered easily after a reasonable number of cases and was associated with safe and satisfactory short- and long-term outcomes before and after learning curve.
Sections du résumé
BACKGROUND
Linear-shaped gastroduodenostomy (LSGD) is a new method of intracorporeal reconstruction that is simpler to perform and associated with a lower rate of bile reflux than delta-shaped anastomosis. Here, we analyzed the learning curve of LSGD in totally laparoscopic distal gastrectomy.
METHODS
The cumulative sum method was used to retrospectively analyze consecutive gastric cancer patients undergoing intracorporeal gastroduodenostomy after distal gastrectomy between January 2009 and May 2016. The duration of surgery, postoperative complications, hospital stay, and endoscopic findings in the postoperative period and the first, third, and fifth year were evaluated according to the two phases of the learning curve (learning period versus mastery period).
RESULTS
Data from 222 patients were included in the analysis. The LSGD learning period was 29 cases. The surgical time in mastery period was significantly shorter than the learning period (124.9 ± 34.5 versus 168.2 ± 42.0 min, p < 0.001). The incidence of minor complications was significantly reduced after the learning period (p = 0.041), although there was no statistically significant difference in the rate of major complications. The long-term endoscopic findings showed that the presence of residual food decreased over the time (p = 0.022).
CONCLUSIONS
LSGD can be mastered easily after a reasonable number of cases and was associated with safe and satisfactory short- and long-term outcomes before and after learning curve.
Identifiants
pubmed: 31325136
doi: 10.1007/s11605-019-04329-3
pii: 10.1007/s11605-019-04329-3
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1770-1777Références
Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surgical laparoscopy & endoscopy. 1994;4(2):146–148.
Kinoshita T, Uyama I, Terashima M, Noshiro H, Nagai E, Obama K, Tamamori, Y, Nabae, T, Honda, M, Abe, T. Long-term Outcomes of Laparoscopic Versus Open Surgery for Clinical Stage II/III Gastric Cancer: A Multicenter Cohort Study in Japan (LOC-A Study). Ann Surg. 2018.
Lee HH, Song KY, Lee JS, Park SM, Kim JJ. Delta-shaped anastomosis, a good substitute for conventional Billroth I technique with comparable long-term functional outcome in totally laparoscopic distal gastrectomy. Surg Endosc. 2015;29(9):2545–2552.
doi: 10.1007/s00464-014-3966-z
Kanaya S, Gomi T, Momoi H, Tamaki N, Isobe H, Katayama T, Wada, Y, Ohtoshi, M. Delta-shaped anastomosis in totally laparoscopic billroth i gastrectomy: new technique of intraabdominal gastroduodenostomy11No competing interests declared. Journal of the American College of Surgeons. 2002;195(2):284–287.
doi: 10.1016/S1072-7515(02)01239-5
Information Committee of Korean Gastric Cancer Association. Korean Gastric Cancer Association Nationwide Survey on Gastric Cancer in 2014. J Gastric Cancer. 2016;16(3):131–140.
doi: 10.5230/jgc.2016.16.3.131
Lee SW, Tanigawa N, Nomura E, Tokuhara T, Kawai M, Yokoyama K, Hiramatsu, M, Okuda, J, Uchiyama, K. Benefits of intracorporeal gastrointestinal anastomosis following laparoscopic distal gastrectomy. World J Surg Oncol. 2012;10:267.
doi: 10.1186/1477-7819-10-267
Noshiro H, Iwasaki H, Miyasaka Y, Kobayashi K, Masatsugu T, Akashi M, Ikeda, O. An additional suture secures against pitfalls in delta-shaped gastroduodenostomy after laparoscopic distal gastrectomy. Gastric Cancer. 2011;14(4):385–389.
doi: 10.1007/s10120-011-0082-9
Okabe H, Obama K, Tsunoda S, Tanaka E, Sakai Y. Advantage of completely laparoscopic gastrectomy with linear stapled reconstruction: a long-term follow-up study. Ann Surg. 2014;259(1):109–116.
doi: 10.1097/SLA.0b013e31828dfa5d
Song HM, Lee SL, Hur H, Cho YK, Han S-U. Linear-Shaped Gastroduodenostomy in Totally Laparoscopic Distal Gastrectomy. Journal of Gastric Cancer. 2010;10(2):69.
doi: 10.5230/jgc.2010.10.2.69
Byun C, Cui LH, Son SY, Hur H, Cho YK, Han SU. Linear-shaped gastroduodenostomy (LSGD): safe and feasible technique of intracorporeal Billroth I anastomosis. Surg Endosc. 2016;30(10):4505–4514.
doi: 10.1007/s00464-016-4783-3
Jeong O, Jung MR, Park YK, Ryu SY. Safety and feasibility during the initial learning process of intracorporeal Billroth I (delta-shaped) anastomosis for laparoscopic distal gastrectomy. Surgical endoscopy. 2015;29(6):1522–1529.
doi: 10.1007/s00464-014-3836-8
Kanaya S, Kawamura Y, Kawada H, Iwasaki H, Gomi T, Satoh S, Uyama, I. The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy. Gastric Cancer. 2011;14(4):365–371.
doi: 10.1007/s10120-011-0054-0
Oh DK, Hur H, Kim JY, Han S-U, Cho YK. V-shaped Liver Retraction during a Laparoscopic Gastrectomy for Gastric Cancer. Journal of Gastric Cancer. 2010;10(3):133.
doi: 10.5230/jgc.2010.10.3.133
Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14(2):101–112.
doi: 10.1007/s10120-011-0041-5
Japanese Gastric Cancer Association . Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14(2):113–123.
doi: 10.1007/s10120-011-0042-4
Makoto Kubo, Takuji Gotoda, Hiroyuki Ono, Mitsuhiro Fujishiro, Daizo Saito,Takeshi Sano, and Hitoshi Katai. Endoscopic evaluation of the remnant stomach after gastrectomy : proposal for a new classification. Gastric Cancer. 2002;5: 83–89.
doi: 10.1007/s101200200014
Wang M, Meng L, Cai Y, Li Y, Wang X, Zhang Z, Peng, B. Learning Curve for Laparoscopic Pancreaticoduodenectomy: a CUSUM Analysis. J Gastrointest Surg. 2016;20(5):924–935.
doi: 10.1007/s11605-016-3105-3
Jang CE, Lee SI. Modified intracorporeal gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer: early experience. Ann Surg Treat Res. 2015;89(6):306–312.
doi: 10.4174/astr.2015.89.6.306
Watanabe Y, Watanabe M, Suehara N, Saimura M, Mizuuchi Y, Nishihara K, Iwashita, T, Nakano, T. Billroth-I reconstruction using an overlap method in totally laparoscopic distal gastrectomy: propensity score matched cohort study of short- and long-term outcomes compared with Roux-en-Y reconstruction. Surg Endosc. 2019.
Huang K-H, Lan Y-T, Fang W-L, Chen J-H, Lo S-S, Li AF-Y, Chiou, S-H, Wu, C-W, Shyr, Y-M. Comparison of the Operative Outcomes and Learning Curves between Laparoscopic and Robotic Gastrectomy for Gastric Cancer. PLoS ONE. 2014;9(10):e111499.
doi: 10.1371/journal.pone.0111499
Zhou J, Shi Y, Qian F, Tang B, Hao Y, Zhao Y, Yu, P. Cumulative summation analysis of learning curve for robot-assisted gastrectomy in gastric cancer. J Surg Oncol. 2015;111(6):760–767.
doi: 10.1002/jso.23876
Biswas P, Kalbfleisch JD. A risk-adjusted CUSUM in continuous time based on the Cox model. Stat Med. 2008;27(17):3382–3406.
doi: 10.1002/sim.3216
Poloniecki J, Valencia O, Littlejohns P. Cumulative risk adjusted mortality chart for detecting changes in death rate: observational study of heart surgery. Bmj. 1998;316(7146):1697–1700.
doi: 10.1136/bmj.316.7146.1697