Department of Surgery, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
Department of Statistics, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
Int J Surg. 2020 Aug;80:61-67. doi: 10.1016/j.ijsu.2020.05.009. Epub 2020 Jul 7.
Laparoscopic pancreatoduodenectomy (LPD) remains an extremely demanding surgery. The purpose of this study was to describe the learning curve required for its safe implementation.
Fifty consecutive patients undergoing LPD were retrospectively reviewed. The learning curve was clustered into 4 groups: A, B and C (initial phase, n = 10 each) and D (consolidation phase, n = 20). Cumulative Sum (CUSUM) analysis was applied to operative time, conversion rate and severe postoperative complications.
No significant differences were observed among groups and phases concerning specific and general postoperative complications, oncological outcomes or mortality. The conversion rate significantly reduced from 90% (9) in Group A to 40% (4) in Group C (p < 0.01). Operative time was longer in the consolidation phase (median of 506 vs 437 min, p < 0.01). Conversely, hospital stays were shorter during the consolidation phase (8 vs 15 days, p < 0.01). CUSUM analysis identified 20-25cases as being enough to complete the learning curve if operative time and severe complications are analysed, while 40 cases would be needed for considering the conversion rate.
The learning curve in LPD can be completed after 20-25 procedures. This information will help to design programmes for introducing new surgeons to this technique.
腹腔镜胰十二指肠切除术（LPD）仍然是一项极具挑战性的手术。本研究旨在描述其安全实施所需的学习曲线。
回顾性分析了 50 例连续接受 LPD 的患者。学习曲线分为 4 组：A、B 和 C（初始阶段，每组 10 例）和 D（巩固阶段，20 例）。累积和（CUSUM）分析用于手术时间、转化率和严重术后并发症。
各组和各阶段在特定和一般术后并发症、肿瘤学结果或死亡率方面无显著差异。转化率从 A 组的 90%（9 例）显著降至 C 组的 40%（4 例）（p<0.01）。在巩固阶段，手术时间更长（中位数分别为 506 分钟和 437 分钟，p<0.01）。相反，在巩固阶段，住院时间更短（8 天与 15 天，p<0.01）。CUSUM 分析表明，如果分析手术时间和严重并发症，则需要 20-25 例病例即可完成学习曲线，而如果考虑转化率，则需要 40 例病例。
LPD 的学习曲线可在 20-25 例手术后完成。这些信息将有助于为新外科医生引入该技术设计计划。
