Stepwise education for pancreaticoduodenectomy for young surgeons at a single Japanese institute

Expert technique and special anatomical or physiological knowledge are needed in the field of pancreatic surgery. The establishment of basic policies and operative techniques for pancreaticoduodenectomy (PD) and stepwise training for young pancreatic surgeons are necessary.

We scheduled PD for ampullar, biliary and pancreas carcinoma, and evaluated types of pancreatic anastomosis or results by each operator such as a chief, fellowship and resident doctors (> 5 years after graduation).

Based on a questionnaire distributed to young residents (n = 30), only half of them have experienced PD or PPPD, which was related to operating volume at the hospital. Post-operative complications at the teaching hospital were observed in 50 of 88 patients (56%). Post-operative complications were not significantly correlated with the type of anastomosis; however, duct-to-mucosa anastomosis of the pancreas might decrease pancreatic fistula (0% vs. 26% in pancreaticogastrostomy and 13% in pancreaticojejunostomy without duct-to-mucosa anastomosis). Based on the stepwise education protocol of technique, patient demographics, the surgical records and the post-operative complications were not significantly different between experienced teaching surgeons, fellowship surgeons and senior residents, although the time of operation and anastomosis tended to be longer in resident surgeons (p = 0.22).

Competent operative techniques for inexperienced surgeons and the achievement of safe resection at each stage are our educational goals for PD.