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Background  Many studies have reported factors affecting pancreatic leakage after pancreaticoduodenectomy ( PD ), but there have been few reports on surgeon workload and post‐operative pancreatic fistula ( POPF ). This study was conducted to explore whether a surgeon's workload during  PD  impacts the occurrence of  POPF .    Methods  We retrospectively analysed 270 consecutive patients who underwent  PD  between  J anuary 2008 and  J une 2013 by a single experienced surgeon. These patients were divided into those who underwent  PD  entirely by a single operator (group 1) and those who received reconstructions by other operators (group 2). Duct‐to‐mucosa pancreaticojejunostomy was performed on all patients. The  I nternational  S tudy  G roup on  P ancreatic  F istula criteria were used to define  POPF .    Results  There were 157 patients (58.1%) in group 1 and 113 patients (41.9%) in group 2. The post‐operative morbidity rate was comparable between the two groups (55.4% versus 52.2%;  P  = 0.603), but the clinical pancreatic fistula (grade  B / C ) rate was significantly different (10.8% versus 2.7%;  P  = 0.011). The overall post‐operative mortality was one patient (0.4%). Significant associations were found between clinical pancreatic fistulas and soft pancreas texture ( P  = 0.021), preoperative serum albumin level ≤3.5 g/d L  ( P  = 0.012), other pathology besides pancreatic cancer ( P  = 0.027) and a single‐operator procedure ( P  = 0.019). A multivariate logistic regression analysis revealed that a single operator (odds ratio: 4.2,  P  = 0.029) was a significant predictive risk factor for clinically relevant  POPF .    Conclusion  Dividing the surgeon's workload in  PD  is associated with lower rates of  POPF .

Division of surgeon workload in pancreaticoduodenectomy: striving to decrease post‐operative pancreatic fistula