Identification of factors affected by a learning curve for laparoscopic rectal resection

Objective: The aim of this study was to identify factors affected by surgeon’s experience of laparoscopic resection for rectal cancer.
Methods: A total of 200 consecutive resections between June1995 and August 2007 were analyzed in an attempt to define a learning curve. These resections were divided into three groups, which were operated on by surgeons with 20 or less, 21 to 40, or 41 or more experience, respectively. The groups were compared to determine if any improvement in operating time, conversion rate, complication rate (including leakage rate and wound infection rate), and length of stay developed as individual experience increased. Multifactorial logistic regression analysis was used to identify surgeon-, patient-, and procedure-related factors associated with operating time and wound infection.
Results: 115 patients were operated on by surgeons having 20 or less experience, and 45 and 39 patients done by surgeons having 21 to 40 and 40 or more experience, respectively. A significant decrease in mean operating time was observed from 226 min to 184 min over first 40 cases. Conversion rate and wound infection also significantly decreased from 10% to 2% and from 12% to 4% over 20 experience. Total complication rate and length of stay were not associated with a surgeon’s experience. Multifactorial analysis showed that independent predictors were the body mass index (BMI) (odds ratio [OR]=2.3, p=0.04), total mesorectal excision (OR=3.3, p=0.04), and surgeon’s experience (OR=3.0, p=0.03) for long operating time (>240 min), and the BMI (OR=3.0, p=

Session: Poster

Program Number: P090

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