Analysis of the Learning Curve in Laparoscopic Colorectal Surgery for General Surgeons
Keywords:
CUSUM analysis, Laparoscopic colorectal surgery, Learning curve, General surgeonsAbstract
Laparoscopic colorectal surgery (LCRS) is less invasive and widely accepted. This study aims to analyze the learning curve of general surgeons performing LCRS and assess related clinical outcomes. A retrospective review was conducted on patients who underwent LCRS at Chaophraya Yommarat Hospital between September 2016 and December 2024, performed by a single general surgeon. To analyze the learning curve, the study explored differences in operative time between the early learning phase and the proficient phases, evaluated using a cumulative sum chart (CUSUM).
A total of 92 patients were included in the study. The results of the CUSUM analysis revealed that the peak operative time corresponded with case 32, thus dividing the study into two phases: Phase 1 (early learning phase, cases 1–32) and Phase 2 (proficient phase, cases 33–92). All surgeries were successfully completed laparoscopically without conversion to open surgery, and negative surgical margins (R0 resection) were achieved in all cases. As experience increased, a trend toward reduced operative time was observed. The intraoperative blood loss significantly decreased during the proficient phase. No differences were found in the rates of severe surgical complications, lymph node yield and postoperative length of hospital stay.
In conclusion, the learning curve of laparoscopic colorectal surgery demonstrated that general surgeons without specialized laparoscopic training could achieve proficiency after performing 32 cases.
Downloads
References
Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomized controlled trial. Lancet. 2005;365:1718-26.
Yilmaz EM, Karacan E. Learning curve at laparoscopic colorectal surgery. Turk J Colorectal Dis. 2020;30(1):37-41.
Lee MTG, Chiu CC, Wang CC, Chang CN, Lee SH, Hsu TC, et al. Trends and outcomes of surgical treatment for colorectal cancer between 2004 and 2012- an analysis using a national inpatient database. Sci Rep. 2017;7(1):2006.
Luján J, Gonzalez A, Abrisqueta J, et al. The learning curve of laparoscopic treatment of rectal cancer does not increase morbidity. Cir Esp. 2014;92(7):485–90.
Luglio G, de Palma GD, Tarquini R, et al. Laparoscopic colorectal surgery in learning curve: Role of implementation of a standardized technique and recovery protocol. A cohort study. Ann Med Surg. 2015;4(2):89-94.
Gkionis IG, Flamourakis ME, Tsagkataki ES, et al. Multidimensional analysis of the learning curve for laparoscopic colorectal surgery in a regional hospital: the implementation of a standardized surgical procedure counterbalances the lack o experience. BMJ Surg. 2020;20:308.
Miskovic D, Ni M, Wyles SM, et al. Learning curve and case selection in laparoscopic colorectal surgery: systematic review and international multicenter analysis of 4852 cases. Dis Colon Rectum. 2012;55(12):1300-10.
Lin PL, et al. CUSUM learning curves: what they can and can’t tell us. Surg Endosc. 2023;37:7991-9.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13.
Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187-96.
Lee JE, Kim KE, Jeong WK, Baek SK, Bae SU. Effect of postoperative complication on 5-year survival following laparoscopic surgery for resectable colorectal cancer: a retrospective study. Int J Colorectal Dis. 2024;39(1):179.
Park EJ, Baik SH, Kang J, Hur H, Min BS, Lee KY, et al. The impact of postoperative complications on long-term oncologic outcomes after laparoscopic low anterior resection for rectal cancer. Medicine (Baltimore). 2016;95(14):e3271.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Singburi Hospital Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The published articles are copyrighted by Singburi Hospital.
The statements appearing in each article in this academic journal are the personal opinions of each author and are not related in any way to Singburi Hospital or other hospital personnel. Each author is solely responsible for all contents of their article. If there are any errors, each author alone will be responsible for their own article.
