Gastric Cancer

, Volume 22, Issue 5, pp 1069–1080 | Cite as

Operation time as a simple indicator to predict the overcoming of the learning curve in gastric cancer surgery: a multicenter cohort study

  • Tae-Han Kim
  • Keun Won Ryu
  • Jun Ho Lee
  • Gyu-Seok Cho
  • Woo Jin Hyung
  • Chan-Young Kim
  • Min-Chan Kim
  • Seung Wan Ryu
  • Dong Woo Shin
  • Hyuk-Joon LeeEmail author
Original Article



The aim of this study is to identify an indicator to predict the overcoming of the learning curve of distal gastrectomy in gastric cancer surgery.


A retrospective multicenter cohort study was conducted in 2100 patients who underwent radical distal gastrectomy performed by nine surgeons in eight hospitals between 2001 and 2006. For each surgeon, an individual CUSUM chart was formulated in terms of operation time or clinical outcomes, including severe complications, number of retrieved lymph nodes, positive resection margin, and hospital stay. The actual changing points (CPs) of the CUSUM charts were analyzed. Based on the CP, patients were divided into pre-CP and post-CP groups, and the clinicopathologic outcomes and survival data were compared between the groups.


CP determined by operation time was more reliable than CP determined by a combination of clinical outcomes, as the former was correlated not only with short-term outcomes but also with survival. The outcomes were superior in the post-CP group in terms of numbers of harvested lymph nodes, sufficient lymph node harvesting (> 15), and negative proximal margins. In a survival analysis, the post-CP group showed better survival than the pre-CP group in stage II (76% vs 86.1% p = 0.010) and stage III (51.5% vs 60.6% p = 0.042).


Overcoming the learning curve of distal gastrectomy for gastric cancer can be better predicted by operation time rather than by a combination of postoperative clinical parameters. It is recommended that surgeons initially operate on early stage cancer patients before overcoming the learning curve.


Gastrectomy Learning Cancer 



No financial interest to disclose.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human rights statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.


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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2019

Authors and Affiliations

  1. 1.Department of Surgery and Cancer Research InstituteSeoul National University HospitalSeoulSouth Korea
  2. 2.Cancer Research InstituteSeoul National UniversitySeoulSouth Korea
  3. 3.Gastric Cancer CenterNational Cancer CenterGoyangSouth Korea
  4. 4.Department of SurgerySoon Chun Hyang University Bucheon HospitalBucheonSouth Korea
  5. 5.Department of SurgeryYonsei University Severance HospitalSeoulSouth Korea
  6. 6.Department of SurgeryChonbuk National University HospitalJeonjuSouth Korea
  7. 7.Department of SurgeryDong-A University HospitalBusanSouth Korea
  8. 8.Department of SurgeryKeimyung University Dongsan HospitalDaeguSouth Korea
  9. 9.Department of SurgeryHallym University Dongtan Sacred Heart HospitalHwaseongSouth Korea
  10. 10.Department of SurgerySamsung Medical CenterSeoulSouth Korea
  11. 11.Department of SurgeryGyeongsang National University Changwon HospitalChangwonSouth Korea

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