Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands.
Department of Abdominal Surgery, University Hospitals KU Leuven, Leuven, Belgium.
Ann Surg. 2019 Feb;269(2):344-350. doi: 10.1097/SLA.0000000000002563.
The aim of the study was to assess feasibility and outcomes of a multicenter training program in laparoscopic pancreatoduodenectomy (LPD).
Whereas expert centers have reported promising outcomes of LPD, nationwide analyses have raised concerns on its safety, especially during the learning curve. Multicenter, structured LPD training programs reporting outcomes including the first procedures are lacking. No LPD had been performed in the Netherlands before this study.
During 2014-2016, 8 surgeons from 4 high-volume centers completed the Longitudinal Assessment and Realization of Laparoscopic Pancreatic Surgery (LAELAPS-2) training program in LPD, including detailed technique description, video training, and proctoring. In all centers, LPD was performed by 2 surgeons with extensive experience in pancreatic and laparoscopic surgery. Outcomes of all LPDs were prospectively collected.
In total, 114 patients underwent LPD. Median pancreatic duct diameter was 3 mm [interquartile range (IQR = 2-4)] and pancreatic texture was soft in 74% of patients. The conversion rate was 11% (n = 12), median blood loss 350 mL (IQR = 200-700), and operative time 375 minutes (IQR = 320-431). Grade B/C postoperative pancreatic fistula occurred in 34% of patients, requiring catheter drainage in 22% and re-operation in 2%. A Clavien-Dindo grade ≥ III complication occurred in 43% of patients. Median length of hospital stay was 15 days (IQR = 9-25). Overall, 30-day and 90-day mortality were both 3.5%. Outcomes were similar for the first and second part of procedures.
This LPD training program was feasible and ensured acceptable outcomes during the learning curve in all centers. Future studies should determine whether such a training program is applicable in other settings and assess the added value of LPD.
本研究旨在评估腹腔镜胰十二指肠切除术（LPD）多中心培训计划的可行性和结果。
虽然专家中心报告了 LPD 的良好结果，但全国性分析对其安全性提出了担忧，尤其是在学习曲线期间。缺乏报告包括第一阶段手术在内的多中心、结构化的 LPD 培训计划。在本研究之前，荷兰尚未开展 LPD。
在 2014-2016 年期间，来自 4 家高容量中心的 8 名外科医生完成了 LPD 的纵向评估和实现腹腔镜胰腺手术（LAELAPS-2）培训计划，包括详细的技术描述、视频培训和监督。在所有中心，LPD 均由 2 名具有丰富胰腺和腹腔镜手术经验的外科医生进行。所有 LPD 的结果均前瞻性收集。
共有 114 例患者接受了 LPD。中位胰管直径为 3mm[四分位距（IQR=2-4）]，74%的患者胰脏质地柔软。转化率为 11%（n=12），中位出血量 350ml[IQR=200-700]，手术时间 375 分钟[IQR=320-431]。术后 B/C 级胰瘘发生率为 34%，22%需要导管引流，2%需要再次手术。43%的患者发生了 Clavien-Dindo 分级≥3 级的并发症。中位住院时间为 15 天[IQR=9-25]。总体而言，30 天和 90 天死亡率均为 3.5%。第一部分和第二部分手术的结果相似。
该 LPD 培训计划在所有中心的学习曲线期间是可行的，并确保了可接受的结果。未来的研究应确定这种培训计划是否适用于其他环境，并评估 LPD 的附加价值。
