The learning curve of linear-shaped gastroduodenostomy associated with totally laparoscopic distal gastrectomy
- 주제(키워드) Gastric cancer; Gastroenterostomy; Billroth I; Learning curve
- 발행기관 아주대학교
- 지도교수 한상욱
- 발행년도 2020
- 학위수여년월 2020. 2
- 학위명 박사
- 학과 및 전공 일반대학원 의학과
- 실제URI http://www.dcollection.net/handler/ajou/000000029575
- 본문언어 영어
- 저작권 아주대학교 논문은 저작권에 의해 보호받습니다.
초록/요약
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.
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ACKNOWLEDGEMENTS i
ABSTRACT ii
TABLE OF CONTENTS iii
LIST OF FIGURES iv
LIST OF TABLES v
I. INTRODUCTION 1
II. MATERIALS AND METHODS 4
1. Patients 5
2. LSGD surgical technique 5
3. Endoscopic surveillance and classification of endoscopic findings 8
4. CUSUM and statistical analysis 8
5. Ethics statement 10
III. Results 11
1. CUSUM analysis of the LSGD learning curve 12
2. Comparison of patients’ characteristics and short-term outcomes 14
3. Comparison of long-term endoscopic findings 19
IV. DISCUSSION 22
V. CONCLUSIONS 27
REFERENCES 29
