Learning curve for hand-assisted laparoscopic D2 radical gastrectomy

Table 1 Comparison of general data for hand-assisted laparoscopic D2 radical gastrectomy

Cohort	A (n = 20)	B (n = 20)	C (n = 20)	D (n = 20)	E (n = 20)	F (n = 20)	P value
Age (yr), mean ± SD	58.45 ± 7.80	56.45 ± 9.67	57.30 ± 9.89	59.05 ± 11.66	59.65 ± 7.32	59.95 ± 8.51	0.82
Median (range)	60.0 (34-71)	57.0 (40-75)	56.5 (40-72)	63.0 (36-73)	59.5 (41-75)	60.5 (45-75)
Sex (male:female)	12:8	13:7	12:8	11:9	14:6	13:7	0.95
BMI; mean ± SD	24.24 ± 3.15	24.04 ± 2.94	25.47 ± 3.31	25.28 ± 3.59	24.93 ± 3.26	25.30 ± 3.31	0.64
median (range)	24.7 (19.6-32.0)	23.9 (19.0-31.7)	25. 6 (19.9-31.8)	26.2 (19.0-31.5)	25.1 (19.3-31.9)	25.0 (19.5-31.7)
ASA							0.70
I	1	3	2	1	2	3
II	14	9	14	16	14	12
III	5	8	4	3	4	5
Pre-abdominal operation, n (%)	1 (5)	2 (10)	2 (10)	3 (15)	2 (10)	1 (5)	0.89
Size of tumor (cm), mean ± SD	4.57 ± 1.54	4.64 ± 1.49	4.53 ± 1.46	4.66 ± 1.29	4.96 ± 1.41	4.94 ± 1.54	0.89
median (range)	4.6 (2.2-6.8)	5.3 (2.3-6.2)	4.5 (2.4-6.8)	4.4 (2.2-6.7)	5.2 (2.3-6.7)	5.1 (2.2-6.8)
TNM stage (n)							0.99
I	3	2	3	3	2	2
II	3	4	4	3	2	3
IIIA	3	4	3	4	3	5
IIIB	6	4	3	4	5	2
IV	5	6	7	6	8	8
Open conversion	1	0	1	0	0	0	0.54

ASA: American Society of Anesthesiologists; BMI: Body mass index (calculated as kg/m²); TNM: Tumor-node-metastasis; HALG: Hand-assisted laparoscopic D2 radical gastrectomy.

Table 2 Comparison of intraoperative data for hand-assisted laparoscopic D2 radical gastrectomy

Cohort	A (n = 19)	B (n = 20)	C (n = 19)	D (n = 20)	E (n = 20)	F (n = 20)	P value
Type of operation (n)							0.99
Total gastrectomy	8	7	8	7	8	8
Distal gastrectomy	10	11	9	12	10	9
Proximal gastrectomy	1	2	2	1	2	3
Operative time (min)
Total, mean ± SD	166.26 ± 12.15	159.70 ± 12.36	161.68 ± 12.01	158.30 ± 11.97	162.95 ± 11.27	158.80 ± 11.85	0.30
median (range)	169 (137-185)	158 (139-184)	164 (136-183)	157.5 (136-184)	164.5 (140-182)	157.5 (138-180)
Lap, mean ± SD	43.21 ± 11.20	35.00 ± 7.31	34.11 ± 8.07	35.20 ± 7.63	33.65 ± 6.68	35.55 ± 9.92	0.01
median (range)	43 (25-65)	33 (24-50)	33 (23-54)	36 (22-47)	34 (21-48)	35.5 (18-51)
Blood loss (mL)
mean ± SD	237.89 ± 71.77	231.90 ± 68.42	242.42 ± 71.96	245.55 ± 70.70	225.75 ± 68.65	235.55 ± 64.59	0.96
median (range)	267 (120-340)	248 (125-343)	265 (112-335)	260.5 (120-342)	223 (117-341)	226 (116-335)
Lymph nodes harvested
mean ± SD	17.74 ± 4.56	18.25 ± 3.78	19.26 ± 2.26	18.47 ± 3.58	18.37 ± 3.55	19.16 ± 3.39	0.78
median (range)	17 (10-23)	18.5 (11-23)	19 (12-23)	19 (12-23)	19 (12-23)	19 (13-23)
Unexpected injury	0	0	0	0	0	0

HALG: Hand-assisted laparoscopic D2 radical gastrectomy.

Table 3 The comparison of postoperative data for hand-assisted laparoscopic D2 radical gastrectomy

Cohort	A (n = 19)	B (n = 20)	C (n = 19)	D (n = 20)	E (n = 20)	F (n = 20)	P value
Functional recovered bowel (h)
mean ± SD	65.58 ± 10.53	55.65 ± 12.13	57.42 ± 10.92	54.65 ± 11.33	55.35 ± 9.81	56.25 ± 9.95	0.02
Median (range)	63 (44-93)	52.5 (41-83)	56 (37-82)	54 (38-75)	54 (38-77)	55 (41-80)
Length of stay (d)
mean ± SD	9.79 ± 1.78	8.75 ± 1.77	8.53 ± 1.74	8.55 ± 1.28	8.60 ± 1.67	8.50 ± 1.40	0.11
median (range)	10 (7-13)	8.5 (6-13)	8 (6-12)	8 (7-12)	8.5 (6-13)	8 (6-12)
Complication (total)	3	3	3	1	2	2	0.89
Pulmonary infection		1	1
Arrhythmia				1
Anastomotic leak	1
Gastrointestinal dysfunction	1	1			1
Bile back flow		1				1
Abdominal cavity infection			1
Wound infect	1		1		1	1
Reoperation	1						0.39
Readmission	1	1	2		1		0.59

HALG: Hand-assisted laparoscopic D2 radical gastrectomy.