Carlo Marino, MD, Cristián Jarry, MD, Vanessa Ahumada, Fernando Crovari, MD, Rodrigo Muñoz, Nicolás Quezada, Enrique Norero, Julián Varas, Pablo Achurra. Pontificia Universidad Católica de Chile
Background: Laparoscopic gastrectomy has shown to be a feasible approach for gastric cancer but involves long learning curves. As a learning curve progress, operating time, complications and conversion rates commonly diminish.
The aim of this study is to describe our experience and learning curve in laparoscopic gastrectomies in gastric cancer patients.
Methods: Retrospective study of our prospective database. Data from all gastric cancer associated gastrectomies between March 2005 and August 2017 performed in our center, were recorded. Surgical approach (open / laparoscopic), operative time (minutes), early complications, biopsy record and other perioperative variables were considered of interest. Our center's first laparoscopic gastrectomy for gastric cancer was done in 2005. Statistical analysis was performed, using non-parametric tests as needed.
Results: A total of 331 gastrectomies for gastric cancer were performed through the 12 years recorded. Patients mean age was 61 years. 38% (128) of all gastrectomies were performed by a laparoscopic approach. During the first year (2005), only 4 out of 35 gastrectomies (11%) were minimally invasive; this proportion showed a progressive growth, reaching 70% (18/26) in 2017.
As the number of cases increased, the learning curve showed improvement in terms of mean operative time (from 7 to 4 hours), early complications rate and conversion rate (from 10% to 5%). Of note, most conversion cases at the beginning of the series were due to the size of the tumor and bleeding, while in the lasts, adherences and vascular involvement mainly explained conversion cases.
At the beginning of our experience, most laparoscopic cases where subtotal gastrectomies but in the final years the rate of laparoscopic approach in total and subtotal gastrectomies was similar (70% and 60% respectively of all gastrectomies).
In terms of tumor size, first 50 laparoscopic cases were significantly smaller than the last 50 cases and also smaller than open approach cases. T0-2stage tumors represented 50% of the first 50 laparoscopic cases, 40% of the last 50 laparoscopic cases and only 25% of open cases (p: 0.001).
Operative time, hospital stay and node count are also reported.
Conclusions: Laparoscopic surgery in gastric cancer has a long learning curve. Mean operative time, conversion rates and complications decrease as experience increases. In our experience, as the learning curve develops, more complex and larger tumors can be safely managed with a minimally invasive approach.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95799
Program Number: P482
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster