Influence of learning curve on short-term results after laparoscopic resection for rectal cancer

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Abstract
Technical difficulties have been encountered in laparoscopic surgery for the treatment of rectal cancer. There are fewer studies about the learning curve for laparoscopic rectal resection. Between June 1995 and August 2007, 200 patients who were scheduled to undergo laparoscopic rectal resection for rectal cancer were enrolled in the study. Each surgeon's operative experience was divided into three groups: 1-20 cases, 21-40 cases, and 41 or more cases. Furthermore, patients were divided chronologically into four groups of 50 patients each. This report describes the association between the learning curves (surgeon's experience and team's experience) and short-term outcomes such as operating time, complication rate, and hospital stay in the case of laparoscopic resection for rectal cancer. We also analyzed how the learning curve influences several postoperative outcomes compared with other clinical factors. The team's experience was not associated with short-term results except for surgical site infection (SSI). On the other hand, surgeon's experience was associated with mean operating time and SSI rate. The endpoints of the learning curve for reducing mean operating time and SSI rate were defined as 40 and 20 cases of laparoscopic rectal resection. In contrast, anastomotic leakage was not associated with surgeon's experience and showed the greatest correlation with total mesorectal excision (TME). Surgeon's learning improved operating time and SSI. On the other hand, low level of anastomosis accompanied with TME was strongly related with leakage, and the association between leakage and surgeon's learning was not clearly demonstrated.