Year 2023 / Volume 115 / Number 11
Original
Learning curve for endoscopic resection of gastric gastrointestinal stromal tumors: a single-center experience

601-607

DOI: 10.17235/reed.2023.9441/2022

Luojie Liu, Xiaodan Xu, Wendao You, Dongtao Shi, Rui Li, Chao Ma,

Abstract
Background: endoscopic resection (ER) is widely used in the treatment of gastric gastrointestinal stromal tumors (gGISTs). However, no studies have previously described the learning curve (LC) for ER of gGISTs. This study aimed to evaluate the LC based on multifarious operative outcomes. Methods: one hundred consecutive patients who underwent ER of gGISTs by a single endoscopist from January 2017 to December 2022 were included. Patients were analyzed in groups of ten to minimize demographic differences, and operative time (OT), conversion rate, intraoperative and postoperative complication were assessed to evaluate the LC. Meanwhile, for the OT, the LC was further analyzed using the cumulative sum (CUSUM) method and patients were organized chronologically in three phases. Result: there was a statistically significant decrease in OT, conversion to laparoscopic surgery, and postoperative complication after 30 cases (median 80.0 min vs 56.0 min, p < 0.001; 10.0 % vs 0 %, p = 0.025; 33.3 % vs 10.0 %, p = 0.004), rate of intraoperative complications after 20 cases (15.0 % vs 1.3 %, p = 0.025). CUSUM chart demonstrated that OT increased dramatically before around 30 cases (phase 1) and decreased after 60 cases (phase 3), with a plateau phase in the middle 30 cases (phase 2). Among the three phases, the R0 resection and conversion rate were not significantly different. However, OT, intraoperative and postoperative complications were gradually decreased (p < 0.05). Conclusions: the LC of ER of gGISTs is approximately 60 cases. However, about 30 cases were sufficient to acquire skills to reduce complications and conversion rate during the ER procedure.
Lay Summary
This study analyzed the learning curve (LC) for endoscopic resection (ER) of gastric gastrointestinal stromal tumors (gGISTs) based on operative outcomes, including operative time, conversion rate, and intra- and postoperative complications. The study included 100 consecutive patients who underwent ER of gGISTs by a single endoscopist, analyzed in groups of 10 to minimize demographic differences and operative time. The results showed a significant decrease in operative time, conversion to laparoscopic operation, and postoperative complication after 30 cases, and in intraoperative complication after 20 cases. The cumulative sum chart demonstrated a rise in operative time before about 30 cases, followed by a decrease after 60 cases, with a plateau in the middle 30 cases. The study concluded that the LC of ER of gGISTs is about 60 cases, with around 30 cases being sufficient to develop skills in reducing complications and conversion rate during ER procedure.
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Publication history

Received: 23/12/2022

Accepted: 25/04/2023

Online First: 12/05/2023

Published: 13/11/2023

Article revision time: 104 days

Article Online First time: 140 days

Article editing time: 325 days


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