Learning curve of totally laparoscopic distal gastrectomy for gastric cancer: a single teaching hospital study

Introduction
Totally laparoscopic distal gastrectomy (TLDG) for gastric cancer has gradually gained popularity. However, the learning curve of TLDG is rarely reported.

Aim
To determine the learning curve of TLDG for gastric cancer.

Material and methods
We retrospectively reviewed and analyzed the medical records of 80 patients with gastric cancer who underwent TLDG with lymph node dissection from January 2016 to December 2017. We divided the patients into four groups based on when they underwent TLDG: group A (cases 1–20), group B (cases 21–40), group C (cases 41–60), and group D (cases 61–80). Comparative analyses of clinical data, including clinicopathologic characteristics, operative data, and postoperative course, were performed for these groups.

Results
No significant difference was observed between the groups in various clinicopathologic characteristics. Total operative time for group A (168.3 ±14.6 min) was significantly longer than for groups B (152.5 ±10.5 min), C (154.2 ±11.6 min), and D (155.3 ±10.8 min), but there was no significant difference between groups B, C, and D. Anastomosis time for group A (27.5 ±12.4 min) was significantly longer than for groups B (15.3 ±4.6 min), C (16.6 ±5.7 min), and D (15.4 ±4.5 min), but there was no significant difference between groups B, C, and D. Non-anastomosis time, estimated blood loss, retrieved lymph nodes, time to first flatus, time to first oral intake, and postoperative hospital stay and complications showed no difference between the four groups.

Conclusions
An experience of approximately 20 cases of TLDG was required to complete the learning curve.