Purpose: There is little information on patient selection criteria for laparoscopy-assisted distal gastrectomy (LADG) that would facilitate a successful initial experience for a surgeon new to the procedure. The aims of this multicenter study were to assess the effect between operation time and frequency of LADG and determine patient selection criteria that will allow increased proficiency and shorter operation times for the LADG procedure.
Method: A retrospective multicenter study was carried out in Korea on 1485 patients who had undergone LAG with extraperigastric lymph node dissection for gastric cancer by ten surgeons at ten institutions during the period May 1998 to December 2005. Among the patients 451 patients were selected initial consecutive fifth patients each surgeons except Laparoscopic assisted total gastrectomy ( 36 patients) and Laparoscopic assisted pylorus preserving proximal gastrectomy (13 patients). We divided these patient by the frequency of LADG procedure into two categories: LAG(laparoscopic assisted gastrectomy) procedure was done lesser than 3 times per a month (Group I : n=169), and LAG procedure was done more than 4 times per a month (Group II : n=282). Uni-and multivariate analyses were performed to identify factors influencing operation time between two groups.
Results: According to univariate analysis, operation time was influenced by sex, BMI, combined operation, reconstruction methods, and surgical experience, whereas multivariate analysis indicated that operation time was significantly influenced only by BMI and surgical experience.
The same analyses of Group I and II showed that sex, BMI, combined operation, reconstruction methods, and surgical experience, were independently associated with operation time. As BMI increased, so did operation time, whereas operation time decreased with increasing surgical experience and frequency of LAG procedure per a month.
Conclusion: This study suggests that surgeons who have limited experience with this advanced procedure may shorten operation time by considering patient and tumor characteristics in their early attempts at LADG. With a shortened operation time, surgeon with limited experience may become proficient to LADG rapidly.
Program Number: P266