Analysis of learning curve for laparoscopic pancreaticoduodenectomy

Yiping Mou, MD, FACS1, Chao Lu, MS2, Weiwei Jin, MD2, Xiaowu Xu, MD1, Renchao Zhang, MD1, Jiafei Yan3, Yucheng Zhou1, Chaojie Huang1, Jiayu Zhou, MD2, Ronggao Chen2, Jingrui Wang2. 1Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, 2School of medicine, Zhejiang University, 3Department of general surgery, SIR RUN RUN SHAW Hospital

Background:Interest in laparoscopic pancreaticoduodenectomy(LPD) keeps on growing, while reports of large series of this procedure is still limited to a few highly specialized centers. Moreover, few of them analyzed the learning curve of LPD. This study aims to assess the overall clinical outcomes and changes during different learning period of this procedure in our institution.

Methods:All data of 120 patients who underwent LPD between September 2012 and July 2015 in our institution were reviewed retrospectively, including demographic data, operative time, blood loss, morbidity, mortality, length of hospital stay(LOS). All patients were divided into 4 groups in order: Group A (the first 30 patients), Group B (the second 30 patients), Group C (the third 30 patients),Group D(the last 30 patients).The overall clinical outcomes and changes during different learning period were analyzed.

Results:Among 120 patients, 111 of them underwent totally LPD, 9 patients underwent laparoscopic assisted pancreaticoduodenectomy(LAPD). 23(19.2%) patients had a history of abdominal surgery. Pathologic examination confirmed pancreatic ductal adenocarcinoma in 36 patients, ampulla of Vater carcinoma in 31 patients, distal bile duct carcinoma in 14 patients, and other diseases in 39 patients.The mean operative time was 355.81±57.55min, mean blood loss was 177.74±152.64ml. 42(35%) patients developed postoperative complications with no mortality. The average LOS was17.01±9.83d.With accumulating experience of the surgeon, the mean overall operative time tends to decrease from 370.17±52.83min in Group A to 342±73.10min in Group D. Moreover, mean operative time of pancreatojejunostomyand choledochojejunostomy also tends to decrease from 55±8.72min, 39.8±11.68min in Group A to 43.57±7.62min, 27.67±11.81min in Group D respectively. Meanwhile, the clinical outcomes tend to get better. Mean blood loss, morbidity and LOS decreased from 219.33±147.88ml, 43.3%, 18.67±10.03d in Group A to 140±73.60ml, 23.3%, 14.38±6.23d in Group C respectively except for Group D, which expended the operative indications with comparable clinical outcomes with Group C.

Conclusions:The laparoscopic pancreaticoduodenectomy procedure is feasible and safe in our center, and it can be applied into routine practice. Clinical outcomes can be improved with accumulating experience for more than 30 operations by overcoming the learning curve.

Key words: Laparoscopic pancreaticoduodenectomy, Learning curve

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