Learning curve of laparoscopic-assisted radical D2 gastrectomy for gastric cancer        GUI Lin, JIANG Peng-cheng,GUAN Rong-xiang, et al. Department of General Surgery (Laparoscopic Center), Affiliated People’s Hospital of Jiangsu University, Zhenjiang 212002, China
Corresponding author: ZHANG Li-yuan, E-mail：zly8824662@sina.com
Abstract    Objective    To explore learning curve regularity and influence factors of laparoscopic-assisted radical D2 gastrectomy for gastric cancer（LAG-D2）. Methods    The clinical data of 100 cases of LAG-D2 performed by the same team from May 2011 to May 2012 in Department of General Surgery (Laparoscopic Center), Affiliated People’s Hospital of Jiangsu University were analyzed retrospectively. According to the date of operation, all the cases were divided into 5 groups (A-E) successively. Twenty cases were set in each group as an operation stage. Each case was dissected D2 lymph node of the gastric cancer, disconnected gastric peripheral vascular in the endoscopy, reconstructed digestive tract with assisted small incision. Results    There was no statistical difference in age, sex, resection site of the stomach, digestive tract reconstruction, postoperative pathologic staging, postoperative hospital staying of every group (P>0.05). There were statistical difference in the operation time (F=4.610, P=0.002), intraoperative bleeding volume(F=7.626, P=0.000) between the five groups. There was no statistical difference between A, B and C group (P>0.05). There was no statistical difference between D and E group (P>0.05). There were statistical difference between A,B,C group and E,D group (P＜0.05).Lymph node dissection were gold number (homogeneity of variance P=0.903 ): there was no statistical difference between A and B group(P>0.05); there was no statistical difference between C,D and E group (P>0.05); there were statistical difference between A and B group, and the same difference between C,D and E group （P＜0.05）. Two cases of A and B group respectively and 1 case of C group were transferred to laparotomy. The total rate of conversion to laparotomy was 5%. Two cases each group in A, B and C had intraoperative injury. Conclusion    During mature period, the operation time is shortened significantly, and bleeding is decreased significantly without intraoperative accident injury or conversion to laparotomy. The mean number of dissected lymph nodes becomes stable. Improving processing way in perioperative period , appropriate operation frequency ( 60 cases or so) can help the operator with the mature technique for open radical D2 gastrectomy for gastric cancer （OG-D2） and laparoscopic cholecystectomy（LC）to pass through the learning curve of the operation safely.