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Division of surgeon workload in pancreaticoduodenectomy: striving to decrease post‐operative pancreatic fistula
Author(s) -
Kim Dong Hun,
Choi Seong Ho,
Choi Dong Wook,
Heo Jin Seok
Publication year - 2015
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13038
Subject(s) - medicine , pancreatic fistula , pancreaticoduodenectomy , odds ratio , fistula , logistic regression , pancreatic duct , pancreas , surgery , general surgery , gastroenterology
Abstract 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 .