Division of surgeon workload in pancreaticoduodenectomy: striving to decrease post‐operative pancreatic fistula

Abstract

BackgroundMany studies have reported factors affecting pancreatic leakage after pancreaticoduodenectomy (PD), but there have been few reports on surgeon workload and post‐operative pancreatic fistula (POPF). This study was conducted to explore whether a surgeon's workload during PD impacts the occurrence of POPF.MethodsWe retrospectively analysed 270 consecutive patients who underwent PD between January 2008 and June 2013 by a single experienced surgeon. These patients were divided into those who underwent PD entirely by a single operator (group 1) and those who received reconstructions by other operators (group 2). Duct‐to‐mucosa pancreaticojejunostomy was performed on all patients. The International Study Group on Pancreatic Fistula criteria were used to define POPF.ResultsThere were 157 patients (58.1%) in group 1 and 113 patients (41.9%) in group 2. The post‐operative morbidity rate was comparable between the two groups (55.4% versus 52.2%; P = 0.603), but the clinical pancreatic fistula (grade B/C) rate was significantly different (10.8% versus 2.7%; P = 0.011). The overall post‐operative mortality was one patient (0.4%). Significant associations were found between clinical pancreatic fistulas and soft pancreas texture (P = 0.021), preoperative serum albumin level ≤3.5 g/dL (P = 0.012), other pathology besides pancreatic cancer (P = 0.027) and a single‐operator procedure (P = 0.019). A multivariate logistic regression analysis revealed that a single operator (odds ratio: 4.2, P = 0.029) was a significant predictive risk factor for clinically relevant POPF.ConclusionDividing the surgeon's workload in PD is associated with lower rates of POPF.

Three Thousand Consecutive Pancreaticoduodenectomies in a Tertiary Cancer Center: A Retrospective Observational Study

“…If tumor can be diagnosed early, resectability can be increased [ 45 ], so many studies have been performed to find related genes [ 46 , 47 , 48 ]. In addition, detailed strategies during PD have been studied to advance surgical outcomes, including division of surgeon workload, whether to put the pancreatic stent externally or internally, the relationship between the amount of intraoperative fluid during PD and POPF, and others [ 49 , 50 , 51 ].…”

Modified duct-to-mucosa versus conventional pancreaticoenterostomy for pancreaticoduodenectomy: a retrospective cohort study based on propensity score matching analysis

“…PE is the committed step in the PD. Although some random studies and meta-analysis have been carried out, there is no evidence or guidelines on how to establish the best PE after PD [2–4, 6–8, 14, 15]. In recent 20 years, despite a significant decline in surgical mortality, the incidence of postoperative complications remains high (about 50%), and the incidence of serious complications of PD is relatively unchanged [16].…”

“…Among them, PE technique is the most crucial factor. To prevent pancreatic fistula, different types of surgical techniques to treat the residual end of the pancreas have been proposed [1–4, 6–8, 14, 15]. However, the efficacy of these techniques remains controversial, and no one is better than other methods [18].…”

“…The pancreaticoenterostomy (PE) technique is the crucial step in the PD operation [4]. Several pancreatic anastomosis techniques, including end-to-end invaginated PE, duct-to-mucosa PE, conventional end-to-side inserting PE, and pancreaticogastrostomy, have been proposed and used as an alternative option for pancreatic anastomosis.…”

Characteristics of 1‐day postoperative mortality: a comparison with 2‐ to 7‐day postoperative mortality

“…Several factors contribute to postoperative morbidity and mortality; emergency operation, 4,21 surgeons' experience, 22 patient-related and institution-related factors. 19 Night-time surgery is possible factors contributing postoperative complication, because of heavy workload and fatigue, 23 absence of experienced personnel, and highly lethal condition of patients such as ruptured aorta. 24 Therefore, the proper allocation of resource including the reasonable management of operating room schedule is necessary to reduce postoperative morbidity.…”