Registrar performance in minimally invasive distal pancreatectomy and effects on postoperative outcomes.
Consultant
Distal pancreatectomy
Minimally invasive distal pancreatectomy
Postoperative outcomes
Registrars
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
received:
24
07
2020
accepted:
20
05
2021
pubmed:
27
5
2021
medline:
12
11
2021
entrez:
26
5
2021
Statut:
ppublish
Résumé
Minimally invasive distal pancreatectomy (MIDP) is nowadays an established standard procedure for non-locally advanced pancreatic lesions without celio-mesenteric vascular invasion. However, little is known about how the involvement of junior surgeons in MIDP affects postoperative outcomes. We performed a retrospective case series study in order to determine whether registrar involvement in MIDP is associated with adverse outcomes. Data were analyzed from a prospectively created database of consecutive patients undergoing MIDP. Only data from 91 patients who underwent MIDP for non-PDAC lesions were included. Patients were divided in 3 groups: Consultant P1 (first 20 MIDP, n=20), Consultant P2 (after 20 MIDP, n=44), and Registrar group (n=27). Conversion rates and 90-day postoperative outcomes were compared. Conversion rates were 5%, 0%, and 14% in Consultant P1 and P2 and Registrar groups, respectively (P1 vs. P2, p = 0.312 and P1 vs. Registrar, p=0.376). Only Comprehensive Complication Index was higher in Registrar group compared to Consultant P1 group (13 vs. 3.7; p = 0.041). Comparison between Consultant P2 and Registrar groups resulted in a significant higher conversion rate (0 vs. 14%, p = 0.029), increased blood loss (77 vs. 263 ml, p = 0.018), and longer surgery duration (156 vs. 212 min, p=0.001) for registrars MIDP. However, no differences were found in clinically relevant postoperative pancreatic fistula (CR-POPF) (16 vs. 7.5%, p=0.282), Clavien-Dindo severe complication ≥3 score (11 vs. 4%, p=0.396), or length of hospital stay (9 vs. 9 days; p=0.614) between the consultant and registrar cohorts. With all the limitations of a retrospective study with a small sample size, junior surgeons' involvement in MIDP for non-PDAC lesions resulted in higher conversion rate, blood loss and duration of surgery without statistically significant difference on clinical outcomes compared to a consultant.
Sections du résumé
BACKGROUND
BACKGROUND
Minimally invasive distal pancreatectomy (MIDP) is nowadays an established standard procedure for non-locally advanced pancreatic lesions without celio-mesenteric vascular invasion. However, little is known about how the involvement of junior surgeons in MIDP affects postoperative outcomes. We performed a retrospective case series study in order to determine whether registrar involvement in MIDP is associated with adverse outcomes.
METHODS
METHODS
Data were analyzed from a prospectively created database of consecutive patients undergoing MIDP. Only data from 91 patients who underwent MIDP for non-PDAC lesions were included. Patients were divided in 3 groups: Consultant P1 (first 20 MIDP, n=20), Consultant P2 (after 20 MIDP, n=44), and Registrar group (n=27). Conversion rates and 90-day postoperative outcomes were compared.
RESULTS
RESULTS
Conversion rates were 5%, 0%, and 14% in Consultant P1 and P2 and Registrar groups, respectively (P1 vs. P2, p = 0.312 and P1 vs. Registrar, p=0.376). Only Comprehensive Complication Index was higher in Registrar group compared to Consultant P1 group (13 vs. 3.7; p = 0.041). Comparison between Consultant P2 and Registrar groups resulted in a significant higher conversion rate (0 vs. 14%, p = 0.029), increased blood loss (77 vs. 263 ml, p = 0.018), and longer surgery duration (156 vs. 212 min, p=0.001) for registrars MIDP. However, no differences were found in clinically relevant postoperative pancreatic fistula (CR-POPF) (16 vs. 7.5%, p=0.282), Clavien-Dindo severe complication ≥3 score (11 vs. 4%, p=0.396), or length of hospital stay (9 vs. 9 days; p=0.614) between the consultant and registrar cohorts.
CONCLUSIONS
CONCLUSIONS
With all the limitations of a retrospective study with a small sample size, junior surgeons' involvement in MIDP for non-PDAC lesions resulted in higher conversion rate, blood loss and duration of surgery without statistically significant difference on clinical outcomes compared to a consultant.
Identifiants
pubmed: 34036406
doi: 10.1007/s00423-021-02212-x
pii: 10.1007/s00423-021-02212-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2357-2365Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Edwin B, Sahakyan MA, Hilal MA, Besselink MG, Braga M, Fabre JM et al (2017) Laparoscopic surgery for pancreatic neoplasms: the European association for endoscopic surgery clinical consensus conference. Surg Endosc 31:2023–2041
doi: 10.1007/s00464-017-5414-3
Riviere D, Gurusamy KS, Kooby DA, Vollmer CM, Besselink MG, Davidson BR et al (2016) Laparoscopic versus open distal pancreatectomy for pancreatic cancer. Cochrane Database Systematic Rev 4:CD011391
Shin SH, Kim SC, Song KB, Hwang DW, Lee JH, Park KM, Lee YJ (2016) Appraisal of laparoscopic distal pancreatectomy for left-sided pancreatic cancer: a large volume cohort study of 152 consecutive patients. PLoS One 11(9):e0163266
doi: 10.1371/journal.pone.0163266
Liang S, Hameed U, Jayaraman S (2014) Laparoscopic pancreatectomy: indications and outcomes. World J Gastroenterol 20(39):14246–14254
doi: 10.3748/wjg.v20.i39.14246
Mehta SS, Doumane G, Mura T, Nocca D, Fabre JM (2012) Laparoscopic versus open distal pancreatectomy: a single-institution case-control study. Surg Endosc 26(2):402–407
doi: 10.1007/s00464-011-1887-7
Nakamura M, Nakashima H (2013) Laparoscopic distal pancreatectomy and pancreatoduodenectomy: is it worthwhile? A meta-analysis of laparoscopic pancreatectomy. J Hepatobiliary Pancreat Sci 20(4):421–428
doi: 10.1007/s00534-012-0578-7
Nakamura M, Wakabayashi G, Miyasaka Y, Tanaka M, Morikawa T, Unno M, Tajima H, Kumamoto Y, Satoi S, Kwon M, Toyama H, Ku Y, Yoshitomi H, Nara S, Shimada K, Yokoyama T, Miyagawa S, Toyama Y, Yanaga K, Fujii T, Kodera Y, Study Group of JHBPS, JSEPS, Tomiyama Y, Miyata H, Takahara T, Beppu T, Yamaue H, Miyazaki M, Takada T (2015) Multicenter comparative study of laparoscopic and open distal pancreatectomy using propensity score-matching. J Hepatobiliary Pancreat Sci 22(10):731–736
doi: 10.1002/jhbp.268
Balcom JH, Rattner DW, Warshaw AL, Chang Y, Fernandez-del CC (2001) Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg 136(4):391–398
doi: 10.1001/archsurg.136.4.391
Fong Y, Blumgart LH, Fortner JG, Brennan MF (1995) Pancreatic or liver resection for malignancy is safe and effective for the elderly. Ann Surg 222(4):426–434 discussion 34-7
doi: 10.1097/00000658-199522240-00002
Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, Sauter PK, Hruban RH, Riall TS, Schulick RD, Choti MA, Lillemoe KD, Yeo CJ (2006) 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg 10(9):1199–1210 discussion 210-1
doi: 10.1016/j.gassur.2006.08.018
Yeo CJ, Sohn TA, Cameron JL, Hruban RH, Lillemoe KD, Pitt HA (1998) Periampullary adenocarcinoma: analysis of 5-year survivors. Ann Surg 227(6):821–831
doi: 10.1097/00000658-199806000-00005
Napoli N, Kauffmann EF, Perrone VG, Miccoli M, Brozzetti S, Boggi U (2015) The learning curve in robotic distal pancreatectomy. Updat Surg 67(3):257–264
doi: 10.1007/s13304-015-0299-y
Shakir M, Boone BA, Polanco PM, Zenati MS, Hogg ME, Tsung A, Choudry HA, Moser AJ, Bartlett DL, Zeh HJ, Zureikat AH (2015) The learning curve for robotic distal pancreatectomy: an analysis of outcomes of the first 100 consecutive cases at a high-volume pancreatic centre. HPB (Oxford) 17(7):580–586
doi: 10.1111/hpb.12412
Marangoni G, Morris-Stiff G, Deshmukh S, Hakeem A, Smith AM (2012) A modern approach to teaching pancreatic surgery: stepwise pancreatoduodenectomy for trainees. J Gastrointest Surg 16(8):1597–1604
doi: 10.1007/s11605-012-1934-2
Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M, International Study Group on Pancreatic Surgery (ISGPS) (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 161(3):584–591
doi: 10.1016/j.surg.2016.11.014
Schwarz L, Bruno M, Parker NH, Prakash L, Mise Y, Lee JE, Vauthey JN, Aloia TA, Conrad C, Fleming JB, Katz MHG (2015) Active surveillance for adverse events within 90 days: the standard for reporting surgical outcomes after pancreatectomy. Ann Surg Oncol 22(11):3522–3529
doi: 10.1245/s10434-015-4437-z
Silvestri M, Coignac A, Delicque J, Herrero A, Borie F, Guiu B, Fabre JM, Souche R (2019) Level of pancreatic division and postoperative pancreatic fistula after distal pancreatectomy: a retrospective case-control study of 157 patients with non-pancreatic ductal adenocarcinoma lesions. Int J Surg 65:128–133
doi: 10.1016/j.ijsu.2019.03.020
Souche R, Herrero A, Bourel G, Chauvat J, Pirlet I, Guillon F, Nocca D, Borie F, Mercier G, Fabre JM (2018) Robotic versus laparoscopic distal pancreatectomy: a French prospective single-center experience and cost-effectiveness analysis. Surg Endosc 32(8):3562–3569
doi: 10.1007/s00464-018-6080-9
Souche R, Fuks D, Perinel J, Herrero A, Guillon F, Pirlet I, Perniceni T, Borie F, Cunha AS, Gayet B, Fabre JM (2018) Impact of laparoscopy in patients aged over 70 years requiring distal pancreatectomy: a French multicentric comparative study. Surg Endosc 32(7):3164–3173
doi: 10.1007/s00464-018-6033-3
Kimura W, Yano M, Sugawara S, Okazaki S, Sato T, Moriya T, Watanabe T, Fujimoto H, Tezuka K, Takeshita A, Hirai I (2010) Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein: techniques and its significance. J Hepatobiliary Pancreat Sci 17(6):813–823
doi: 10.1007/s00534-009-0250-z
Warshaw AL (1988) Conservation of the spleen with distal pancreatectomy. Arch Surg 123(5):550–553
doi: 10.1001/archsurg.1988.01400290032004
Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Büchler MW (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 142(1):20–25
doi: 10.1016/j.surg.2007.02.001
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
doi: 10.1097/01.sla.0000133083.54934.ae
Hogg ME, Besselink MG, Clavien PA, Fingerhut A, Jeyarajah DR, Kooby DA, Moser AJ, Pitt HA, Varban OA, Vollmer CM, Zeh HJ III, Hansen P, Asbun HJ, Barkun J, Kendrick ML, Kooby DA, Hansen PD, Vollmer CM, Zeh H, Montagnini AL, Besselink MGH, Boggi U, Conlon KCP, Røsok BI, Han HS, Palanivelu C, Shrikhande SV, Wakabayashi G (2017) Training in minimally invasive pancreatic resections: a paradigm shift away from "See one, Do one, Teach one". HPB (Oxford) 19(3):234–245
doi: 10.1016/j.hpb.2017.01.016
Tokunaga M, Hiki N, Fukunaga T, Miki A, Nunobe S, Ohyama S, Seto Y, Yamaguchi T (2009) Quality control and educational value of laparoscopy-assisted gastrectomy in a high-volume center. Surg Endosc 23(2):289–295
doi: 10.1007/s00464-008-9902-3
Phillips AW, Dent B, Navidi M, Immanuel A, Griffin SM (2018) Trainee Involvement in Ivor Lewis Esophagectomy Does Not Negatively Impact Outcomes. Ann Surg 267(1):94–98
doi: 10.1097/SLA.0000000000002047
Relles DM, Burkhart RA, Pucci MJ, Sendecki J, Tholey R, Drueding R, Sauter PK, Kennedy EP, Winter JM, Lavu H, Yeo CJ (2014) Does resident experience affect outcomes in complex abdominal surgery? Pancreaticoduodenectomy as an example. J Gastrointest Surg 18(2):279–285 discussion 85
doi: 10.1007/s11605-013-2372-5
Handagala SD, Addae-Boateng E, Beggs D, Duffy JP, Martin-Ucar AE (2012) Early outcomes of surgery for oesophageal cancer in a thoracic regional unit. Can we maintain training without compromising results? Eur J Cardiothorac Surg 41(1):31–34 discussion 4-5
pubmed: 21622004
Krell RW, Birkmeyer NJ, Reames BN, Carlin AM, Birkmeyer JD, Finks JF, Michigan Bariatric Surgery Collaborative (2014) Effects of resident involvement on complication rates after laparoscopic gastric bypass. J Am Coll Surg 218(2):253–260
doi: 10.1016/j.jamcollsurg.2013.10.014
Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ (2010) Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 11(5):439–449
doi: 10.1016/S1470-2045(10)70070-X
Putnam JB Jr, Suell DM, McMurtrey MJ, Ryan MB, Walsh GL, Natarajan G et al (1994) Comparison of three techniques of esophagectomy within a residency training program. Ann Thorac Surg 57(2):319–325
doi: 10.1016/0003-4975(94)90990-3