Learning curve and surgical factors influencing the surgical outcomes during the initial experience with laparoscopic pancreaticoduodenectomy

Yuichi Nagakawa, Yoshiharu Nakamura, Goro Honda, Yoshitaka Gotoh, Takao Ohtsuka, Daisuke Ban, Kohei Nakata, Yatsuka Sahara, Vittoria Vanessa D.M. Velasquez, Kyoichi Takaori, Takeyuki Misawa, Tamotsu Kuroki, Manabu Kawai, Takanori Morikawa, Hiroki Yamaue, Minoru Tanabe, Yiping Mou, Woo Jung Lee, Shailesh V. Shrikhande, Claudius ConradHo Seong Han, Chung Ngai Tang, Chinnusamy Palanivelu, David A. Kooby, Horacio J. Asbun, Go Wakabayashi, Akihiko Tsuchida, Tadahiro Takada, Masakazu Yamamoto, Masafumi Nakamura

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Laparoscopic pancreaticoduodenectomy (LPD) requires sufficient laparoscopic training for optimal outcomes. Our aim is to determine the learning curve and investigate the factors influencing surgical outcomes during the learning curve. Methods: We analyzed surgical results of 150 consecutive cases of LPD performed by three hepatopancreatobiliary surgeons during their 50 first cases. Learning curves were constructed by cumulative sum (CUSUM) analysis. Preoperative factors influencing resection time and blood loss were investigated in the introductory and stable periods. Results : The learning curve could be divided into three phases: initial (1–20 cases), plateau (21–30), and stable (31–50). Resection time with lymph node dissection was significantly longer during the introductory period (initial and plateau periods) (P < 0.01) but not the stable phase (P = 0.51). Multivariate analysis revealed that patients with pancreatitis had longer resection times and massive blood loss in both the introductory and stable periods (stable phase). High visceral fat area was also significantly related to massive blood loss in the introductory period (P = 0.04). Conclusions: Hepatopancreatobiliary surgeons need more than 30 cases until LPD becomes stable. Lymph node dissection and patients with high visceral fat area and concomitant pancreatitis should be avoided during the introductory period of the learning curve.

Original languageEnglish
Pages (from-to)498-507
Number of pages10
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Volume25
Issue number11
DOIs
Publication statusPublished - Nov 2018

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Pancreaticoduodenectomy
Learning Curve
Intra-Abdominal Fat
Lymph Node Excision
Pancreatitis
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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Learning curve and surgical factors influencing the surgical outcomes during the initial experience with laparoscopic pancreaticoduodenectomy. / Nagakawa, Yuichi; Nakamura, Yoshiharu; Honda, Goro; Gotoh, Yoshitaka; Ohtsuka, Takao; Ban, Daisuke; Nakata, Kohei; Sahara, Yatsuka; Velasquez, Vittoria Vanessa D.M.; Takaori, Kyoichi; Misawa, Takeyuki; Kuroki, Tamotsu; Kawai, Manabu; Morikawa, Takanori; Yamaue, Hiroki; Tanabe, Minoru; Mou, Yiping; Lee, Woo Jung; Shrikhande, Shailesh V.; Conrad, Claudius; Han, Ho Seong; Tang, Chung Ngai; Palanivelu, Chinnusamy; Kooby, David A.; Asbun, Horacio J.; Wakabayashi, Go; Tsuchida, Akihiko; Takada, Tadahiro; Yamamoto, Masakazu; Nakamura, Masafumi.

In: Journal of Hepato-Biliary-Pancreatic Sciences, Vol. 25, No. 11, 11.2018, p. 498-507.

Research output: Contribution to journalArticle

Nagakawa, Y, Nakamura, Y, Honda, G, Gotoh, Y, Ohtsuka, T, Ban, D, Nakata, K, Sahara, Y, Velasquez, VVDM, Takaori, K, Misawa, T, Kuroki, T, Kawai, M, Morikawa, T, Yamaue, H, Tanabe, M, Mou, Y, Lee, WJ, Shrikhande, SV, Conrad, C, Han, HS, Tang, CN, Palanivelu, C, Kooby, DA, Asbun, HJ, Wakabayashi, G, Tsuchida, A, Takada, T, Yamamoto, M & Nakamura, M 2018, 'Learning curve and surgical factors influencing the surgical outcomes during the initial experience with laparoscopic pancreaticoduodenectomy', Journal of Hepato-Biliary-Pancreatic Sciences, vol. 25, no. 11, pp. 498-507. https://doi.org/10.1002/jhbp.586
Nagakawa, Yuichi ; Nakamura, Yoshiharu ; Honda, Goro ; Gotoh, Yoshitaka ; Ohtsuka, Takao ; Ban, Daisuke ; Nakata, Kohei ; Sahara, Yatsuka ; Velasquez, Vittoria Vanessa D.M. ; Takaori, Kyoichi ; Misawa, Takeyuki ; Kuroki, Tamotsu ; Kawai, Manabu ; Morikawa, Takanori ; Yamaue, Hiroki ; Tanabe, Minoru ; Mou, Yiping ; Lee, Woo Jung ; Shrikhande, Shailesh V. ; Conrad, Claudius ; Han, Ho Seong ; Tang, Chung Ngai ; Palanivelu, Chinnusamy ; Kooby, David A. ; Asbun, Horacio J. ; Wakabayashi, Go ; Tsuchida, Akihiko ; Takada, Tadahiro ; Yamamoto, Masakazu ; Nakamura, Masafumi. / Learning curve and surgical factors influencing the surgical outcomes during the initial experience with laparoscopic pancreaticoduodenectomy. In: Journal of Hepato-Biliary-Pancreatic Sciences. 2018 ; Vol. 25, No. 11. pp. 498-507.
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abstract = "Background: Laparoscopic pancreaticoduodenectomy (LPD) requires sufficient laparoscopic training for optimal outcomes. Our aim is to determine the learning curve and investigate the factors influencing surgical outcomes during the learning curve. Methods: We analyzed surgical results of 150 consecutive cases of LPD performed by three hepatopancreatobiliary surgeons during their 50 first cases. Learning curves were constructed by cumulative sum (CUSUM) analysis. Preoperative factors influencing resection time and blood loss were investigated in the introductory and stable periods. Results : The learning curve could be divided into three phases: initial (1–20 cases), plateau (21–30), and stable (31–50). Resection time with lymph node dissection was significantly longer during the introductory period (initial and plateau periods) (P < 0.01) but not the stable phase (P = 0.51). Multivariate analysis revealed that patients with pancreatitis had longer resection times and massive blood loss in both the introductory and stable periods (stable phase). High visceral fat area was also significantly related to massive blood loss in the introductory period (P = 0.04). Conclusions: Hepatopancreatobiliary surgeons need more than 30 cases until LPD becomes stable. Lymph node dissection and patients with high visceral fat area and concomitant pancreatitis should be avoided during the introductory period of the learning curve.",
author = "Yuichi Nagakawa and Yoshiharu Nakamura and Goro Honda and Yoshitaka Gotoh and Takao Ohtsuka and Daisuke Ban and Kohei Nakata and Yatsuka Sahara and Velasquez, {Vittoria Vanessa D.M.} and Kyoichi Takaori and Takeyuki Misawa and Tamotsu Kuroki and Manabu Kawai and Takanori Morikawa and Hiroki Yamaue and Minoru Tanabe and Yiping Mou and Lee, {Woo Jung} and Shrikhande, {Shailesh V.} and Claudius Conrad and Han, {Ho Seong} and Tang, {Chung Ngai} and Chinnusamy Palanivelu and Kooby, {David A.} and Asbun, {Horacio J.} and Go Wakabayashi and Akihiko Tsuchida and Tadahiro Takada and Masakazu Yamamoto and Masafumi Nakamura",
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T1 - Learning curve and surgical factors influencing the surgical outcomes during the initial experience with laparoscopic pancreaticoduodenectomy

AU - Nagakawa, Yuichi

AU - Nakamura, Yoshiharu

AU - Honda, Goro

AU - Gotoh, Yoshitaka

AU - Ohtsuka, Takao

AU - Ban, Daisuke

AU - Nakata, Kohei

AU - Sahara, Yatsuka

AU - Velasquez, Vittoria Vanessa D.M.

AU - Takaori, Kyoichi

AU - Misawa, Takeyuki

AU - Kuroki, Tamotsu

AU - Kawai, Manabu

AU - Morikawa, Takanori

AU - Yamaue, Hiroki

AU - Tanabe, Minoru

AU - Mou, Yiping

AU - Lee, Woo Jung

AU - Shrikhande, Shailesh V.

AU - Conrad, Claudius

AU - Han, Ho Seong

AU - Tang, Chung Ngai

AU - Palanivelu, Chinnusamy

AU - Kooby, David A.

AU - Asbun, Horacio J.

AU - Wakabayashi, Go

AU - Tsuchida, Akihiko

AU - Takada, Tadahiro

AU - Yamamoto, Masakazu

AU - Nakamura, Masafumi

PY - 2018/11

Y1 - 2018/11

N2 - Background: Laparoscopic pancreaticoduodenectomy (LPD) requires sufficient laparoscopic training for optimal outcomes. Our aim is to determine the learning curve and investigate the factors influencing surgical outcomes during the learning curve. Methods: We analyzed surgical results of 150 consecutive cases of LPD performed by three hepatopancreatobiliary surgeons during their 50 first cases. Learning curves were constructed by cumulative sum (CUSUM) analysis. Preoperative factors influencing resection time and blood loss were investigated in the introductory and stable periods. Results : The learning curve could be divided into three phases: initial (1–20 cases), plateau (21–30), and stable (31–50). Resection time with lymph node dissection was significantly longer during the introductory period (initial and plateau periods) (P < 0.01) but not the stable phase (P = 0.51). Multivariate analysis revealed that patients with pancreatitis had longer resection times and massive blood loss in both the introductory and stable periods (stable phase). High visceral fat area was also significantly related to massive blood loss in the introductory period (P = 0.04). Conclusions: Hepatopancreatobiliary surgeons need more than 30 cases until LPD becomes stable. Lymph node dissection and patients with high visceral fat area and concomitant pancreatitis should be avoided during the introductory period of the learning curve.

AB - Background: Laparoscopic pancreaticoduodenectomy (LPD) requires sufficient laparoscopic training for optimal outcomes. Our aim is to determine the learning curve and investigate the factors influencing surgical outcomes during the learning curve. Methods: We analyzed surgical results of 150 consecutive cases of LPD performed by three hepatopancreatobiliary surgeons during their 50 first cases. Learning curves were constructed by cumulative sum (CUSUM) analysis. Preoperative factors influencing resection time and blood loss were investigated in the introductory and stable periods. Results : The learning curve could be divided into three phases: initial (1–20 cases), plateau (21–30), and stable (31–50). Resection time with lymph node dissection was significantly longer during the introductory period (initial and plateau periods) (P < 0.01) but not the stable phase (P = 0.51). Multivariate analysis revealed that patients with pancreatitis had longer resection times and massive blood loss in both the introductory and stable periods (stable phase). High visceral fat area was also significantly related to massive blood loss in the introductory period (P = 0.04). Conclusions: Hepatopancreatobiliary surgeons need more than 30 cases until LPD becomes stable. Lymph node dissection and patients with high visceral fat area and concomitant pancreatitis should be avoided during the introductory period of the learning curve.

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