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Background: Because laparoscopic liver resection (LLR) has a steep learning curve, analyzing experience is important for trainees. Several authors have described the learning curve of LLR, without comparing the learning curves between major and minor LLR.Methods: Perioperative data were retrieved from the medical records of 170 consecutive patients who underwent LLR by a single surgeon at a tertiary hospital. Learning curves were generated and compared between major and minor LLR using cumulative sum control charts and the moving average.Results: Major and minor LLR was performed in 96 and 74 patients, respectively. The learning curves showed a steady state after case 50 for major LLR. Because of discordant results in minor LLR, subgroup analyses were performed, showing competency in LLR after cases 25 and 35 for left lateral sectionectomy and tumorectomy, respectively. Transfused red blood cell volume (0.6 versus 2.2 packs, P < .001) decreased after achievement of competence in major LLR. Blood loss exceeding 500 mL (odds ratio 2.395, 95% confidence interval 1.096-5.233, P = .028) was independently associated with LLR failure.Conclusions: The number of cases required to accomplish LLR differed according to the extent of resection. Extensive blood loss was independently associated with LLR failure. [ABSTRACT FROM AUTHOR]

Background: Previous studies have examined the relationship between body mass index (BMI) and the behavior of papillary thyroid carcinomas (PTC). However, the results are inconsistent. The purpose of this study was to clarify the association between PTC behavior and anthropometric parameters including BMI and body surface area (BSA). Methods: This study retrospectively reviewed 5081 PTC patients who underwent total thyroidectomy with bilateral central neck dissection between January 2002 and June 2015. Because of sexual dimorphism in obesity, analyses were conducted separately for men and women. The World Health Organization BMI classification was used to classify patients as normal (18.5 = BMI <25 kg/m²), overweight (25 = BMI <30 kg/m²), or obese (BMI =30 kg/m²). Since no consensus for BSA categorization exists, enrolled patients were grouped into BSA quartiles by sex: women BSA1 (BSA <1.52 m²), BSA2 (1.52 = BSA <1.59 m²), BSA3 (1.59 = BSA <1.67 m²), and BSA4 (BSA =1.67 m²); and men BSA1 (BSA <1.77 m²), BSA2 (1.77 = BSA <1.86 m²), BSA3 (1.86 = BSA <1.96 m²), and BSA4 (BSA =1.96 m²). Results: In women, overweight (adjusted odds ratio [OR] = 1.187, p = 0.042) and obese (adjusted OR = 2.231, p < 0.001) were independent predictors for multiplicity. Furthermore, overweight (adjusted OR = 1.237, p = 0.012) and obese (adjusted OR = 1.789, p = 0.005) were independent predictors for extrathyroidal extension (ETE). However, higher BMI was not an independent predictor for bilaterality or central lymph node metastasis (CLNM). In addition, higher BSA--BSA3 (adjusted OR = 1.205, p = 0.049) and BSA4 (adjusted OR = 1.524, p < 0.001)--was an independent predictor for multiplicity. However, higher BSA was not a predictor for bilaterality, ETE, or CLNM. In men, higher BMI and BSA were not predictors for multiplicity, bilaterality, ETE, or CLNM. Conclusions: In women with PTC, higher BMI was an independent predictor for multiplicity and ETE. Furthermore, higher BSA was an independent predictor for multiplicity. However, BMI and BSA were not predictors for the PTC behavior in men. [ABSTRACT FROM AUTHOR]