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Learning curve and surgical factors influencing the surgical outcomes during the initial experience with laparoscopic pancreaticoduodenectomy
Author(s) -
Nagakawa Yuichi,
Nakamura Yoshiharu,
Honda Goro,
Gotoh Yoshitaka,
Ohtsuka Takao,
Ban Daisuke,
Nakata Kohei,
Sahara Yatsuka,
Velasquez Vittoria Vanessa D. M.,
Takaori Kyoichi,
Misawa Takeyuki,
Kuroki Tamotsu,
Kawai Manabu,
Morikawa Takanori,
Yamaue Hiroki,
Tanabe Minoru,
Mou Yiping,
Lee WooJung,
Shrikhande Shailesh V.,
Conrad Claudius,
Han HoSeong,
Tang Chung Ngai,
Palanivelu Chinnusamy,
Kooby David A.,
Asbun Horacio J.,
Wakabayashi Go,
Tsuchida Akihiko,
Takada Tadahiro,
Yamamoto Masakazu,
Nakamura Masafumi
Publication year - 2018
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.586
Subject(s) - medicine , cusum , pancreaticoduodenectomy , dissection (medical) , blood loss , learning curve , concomitant , lymph node , surgery , laparoscopy , general surgery , resection , operations management , management , economics
Abstract Background Laparoscopic pancreaticoduodenectomy ( LPD ) requires sufficient laparoscopic training for optimal outcomes. Our aim is to determine the learning curve and investigate the factors influencing surgical outcomes during the learning curve. Methods We analyzed surgical results of 150 consecutive cases of LPD performed by three hepatopancreatobiliary surgeons during their 50 first cases. Learning curves were constructed by cumulative sum ( CUSUM ) analysis. Preoperative factors influencing resection time and blood loss were investigated in the introductory and stable periods. Results The learning curve could be divided into three phases: initial (1–20 cases), plateau (21–30), and stable (31–50). Resection time with lymph node dissection was significantly longer during the introductory period (initial and plateau periods) ( P < 0.01) but not the stable phase ( P = 0.51). Multivariate analysis revealed that patients with pancreatitis had longer resection times and massive blood loss in both the introductory and stable periods (stable phase). High visceral fat area was also significantly related to massive blood loss in the introductory period ( P = 0.04). Conclusions Hepatopancreatobiliary surgeons need more than 30 cases until LPD becomes stable. Lymph node dissection and patients with high visceral fat area and concomitant pancreatitis should be avoided during the introductory period of the learning curve.