The learning curve of laparoscopic pancreaticoduodenectomy based on the initial 112 patients / 中华肝胆外科杂志

ABSTRACT

Objective To study the learning curve of laparoscopic pacreaticoduodenectomy ( LPD) with a view to find an appropriate way to develop LPD step by step. Methods 112 consecutive patients who completely underwent LPD in a single surgery center at the First People ' s Hospital of Changzhou from December 2015 to February 2018 were retrospectively reviewed. By using both the cumulative sum ( CUSUM) and the risk-adjusted CUSUM ( RA-CUSUM) methods to analyze the perioperative data of these patients, the learning curve of LPD was studied in a more scientific way. Results The learning curve could be divided into three phasesPhase 1, the initial period (the initial 45 patients);Phase 2, the enhancement period (the subsequent 31 patients);Phase 3, the maturation period (the remaining patients). For these 3 phases, the corresponding operative times were (448. 4 ± 75. 0), (381. 3 ± 74. 3), and (336. 2 ± 52. 1) min, respectively (P<0. 05). The intraoperative blood losses were (373. 3 ± 250. 1), (332. 3 ± 211. 6), and (265. 3 ± 253. 2) ml, respectively (P<0. 05). The times to oral intake were 6. 0(5. 0,8. 0), 5. 0 (3. 0,6. 0), and 3. 0(3. 0,5. 0) days, respectively (P<0. 05). The number of lymph nodes harvested were (10. 0 ± 7. 0), (8. 8 ± 4. 3), and (13. 3 ± 6. 2), respectively (P<0. 05). All these showed signifi-cant improvement through the 3 phases. On the other hand, the postoperative stays, the postoperative pan-creatic fistula rates were also decreased. But these failed to reach statistical significance. Vascular reconstruction was carried out in the 48th patient in phase 2 of the study. Conclusions The initial phase of LPD passed after LPD for 46 patients, but the maturation phase occurred after LPD on 76 patients. Vascular reconstruction should be considered as passing through the learning phase rather than reaching the maturity phase. Adjustments made in the enhancement phase helped to get through the maturation phase earlier.