TY - JOUR
T1 - The learning curve in pancreatic surgery (DOI:10.1016/j.surg.2006.09.013)
AU - Tseng, Jennifer F.
AU - Pisters, Peter W.T.
AU - Lee, Jeffrey E.
AU - Wang, Huamin
AU - Gomez, Henry F.
AU - Sun, Charlotte C.
AU - Evans, Douglas B.
N1 - Funding Information:
Supported by the Pancreatic Cancer Alliance (Dr Tseng) and The Lockton Fund for Pancreatic Cancer Research and the Hamill Foundation (M.D. Anderson Cancer Center).
PY - 2007/5
Y1 - 2007/5
N2 - Background: Pancreatic surgery is technically complex. We hypothesized that a learning curve existed for pancreaticoduodenectomy even for surgeons who had completed their training. Methods: During 1990 to 2004, we studied 650 consecutive patients who underwent pancreaticoduodenectomy by 3 surgeons who began their attending careers at 1 center. Operative time, estimated blood loss (EBL), length of hospital stay (LOS), and the status of resection margins (for pancreatic adenocarcinoma) were analyzed. The χ2, independent t test and Mann-Whitney U test were used to evaluate differences in categorical, normally distributed continuous, and non-normally distributed continuous variables, respectively. Using serial groups of 30 cases, median operative time, EBL, and LOS were calculated and the trend over time modeled using third-order polynomial equations. Trends in retroperitoneal margin positivity (R0/R1) were assessed. Results: From the first 60 cases per surgeon to the second 60 cases per surgeon, the median EBL dropped (1100 vs 725 mL, P < .001), operative time decreased (589 vs 513 minutes, P < .001), and LOS decreased (15 vs 13 days, P = .004). The proportion of microscopically positive or suspicious margins also decreased from the surgeons' first 60 cases each to the second 60 cases (30% vs 8%, P < .001). Extended analysis of a single surgeon's cases suggested that additional experience provided further incremental improvement (P < .001). Conclusions: Pancreaticoduodenectomy has an inherent learning curve. After 60 cases, surgeons achieved significantly decreased EBL, operative time, and LOS, and carried out more margin-negative resections. Improvement in measured outcomes continues during the operative career.
AB - Background: Pancreatic surgery is technically complex. We hypothesized that a learning curve existed for pancreaticoduodenectomy even for surgeons who had completed their training. Methods: During 1990 to 2004, we studied 650 consecutive patients who underwent pancreaticoduodenectomy by 3 surgeons who began their attending careers at 1 center. Operative time, estimated blood loss (EBL), length of hospital stay (LOS), and the status of resection margins (for pancreatic adenocarcinoma) were analyzed. The χ2, independent t test and Mann-Whitney U test were used to evaluate differences in categorical, normally distributed continuous, and non-normally distributed continuous variables, respectively. Using serial groups of 30 cases, median operative time, EBL, and LOS were calculated and the trend over time modeled using third-order polynomial equations. Trends in retroperitoneal margin positivity (R0/R1) were assessed. Results: From the first 60 cases per surgeon to the second 60 cases per surgeon, the median EBL dropped (1100 vs 725 mL, P < .001), operative time decreased (589 vs 513 minutes, P < .001), and LOS decreased (15 vs 13 days, P = .004). The proportion of microscopically positive or suspicious margins also decreased from the surgeons' first 60 cases each to the second 60 cases (30% vs 8%, P < .001). Extended analysis of a single surgeon's cases suggested that additional experience provided further incremental improvement (P < .001). Conclusions: Pancreaticoduodenectomy has an inherent learning curve. After 60 cases, surgeons achieved significantly decreased EBL, operative time, and LOS, and carried out more margin-negative resections. Improvement in measured outcomes continues during the operative career.
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U2 - 10.1016/j.surg.2007.04.001
DO - 10.1016/j.surg.2007.04.001
M3 - Comment/debate
C2 - 17511115
AN - SCOPUS:34247199368
SN - 0039-6060
VL - 141
SP - 694
EP - 701
JO - Surgery
JF - Surgery
IS - 5
ER -