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Cited 17 time in webofscience Cited 18 time in scopus
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Evaluation of a single surgeon's learning curve of laparoscopic pancreaticoduodenectomy: risk-adjusted cumulative summation analysis

Authors
Kim, SunghoYoon, Yoo-SeokHan, Ho-SeongCho, Jai YoungChoi, YoungRokLee, Boram
Issue Date
Jun-2021
Publisher
Springer Verlag
Keywords
Laparoscopic pancreaticoduodenectomy; Learning curve; Risk-adjusted CUSUM
Citation
Surgical Endoscopy, v.35, no.6, pp.2870 - 2878
Indexed
SCIE
SCOPUS
Journal Title
Surgical Endoscopy
Volume
35
Number
6
Start Page
2870
End Page
2878
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/28019
DOI
10.1007/s00464-020-07724-z
ISSN
0930-2794
Abstract
Background Laparoscopic pancreaticoduodenectomy (LPD) is technically demanding and there is much controversy about its safety. We evaluated the learning curve for pure LPD based on the clinical outcomes of consecutive patients treated by a single surgeon. Methods We reviewed the medical records of 119 consecutive patients who underwent LPD by a single surgeon between June 2013 and August 2018. The learning curve was evaluated using the cumulative summation (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) methods. Perioperative outcomes were compared among the learning curve phases. Results CUSUM analysis of the operation time showed that the operation time improved after the 47th case. RA-CUSUM analysis showed the learning curve for surgical failure, defined as severe complications (Clavien–Dindo grade ≥ 3) or open conversion, comprised three phases (phase 1: cases 1–60; phase 2: cases 61–83; phase 3: cases 84–119). There were no significant differences in operation time among the three phases. Intraoperative blood loss decreased significantly over the three phases (P = 0.032). There were no postoperative deaths. The rates of postoperative complications, pancreatic fistula (grade B/C), and post-pancreatic hemorrhage were significantly lower in phase 3 than in phase 2 (2.8% vs. 21.7%, P = 0.019; 2.8% vs. 17.4%, P = 0.049; 0% vs. 13.0%, P = 0.026), but not between phases 1 and 2. Postoperative hospital stay decreased progressively, and was significantly shorter in phase 3 than in phase 1 (9.1 vs. 16.7 days, P = 0.001). Conclusions The LPD failure rate decreased after the first 60 cases and stabilized after 84 cases. For safe dissemination of LPD, it is important to shorten the long learning curve and decrease the unfavorable outcomes in the early phase of the learning curve.
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Kim, Sung Ho
안산병원 (Department of Hepato-Biliary-Pancreatic Surgery, Ansan Hospital)
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