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

Area of Science:

• Surgical Oncology
• Gastroenterology
• Clinical Outcomes Research

Background:

• Pancreaticoduodenectomy (PD) is complex, with known risk factors for post-operative pancreatic fistula (POPF).
• Surgeon workload during PD has not been extensively studied in relation to POPF incidence.
• This study investigates the impact of surgeon workload on POPF occurrence after PD.

Purpose of the Study:

• To determine if a surgeon's workload during pancreaticoduodenectomy (PD) influences the rate of post-operative pancreatic fistula (POPF).
• To identify predictive risk factors for clinically relevant POPF in patients undergoing PD.

Main Methods:

• Retrospective analysis of 270 patients undergoing PD by a single experienced surgeon.
• Patients divided into two groups: PD performed entirely by one surgeon versus reconstruction by other surgeons.
• Post-operative pancreatic fistula (POPF) defined using International Study Group on Pancreatic Fistula criteria.

Main Results:

• A single-operator procedure was significantly associated with a higher rate of clinically relevant POPF (10.8% vs. 2.7%, P=0.011).
• Multivariate analysis identified a single operator as a significant predictive risk factor for POPF (OR: 4.2, P=0.029).
• Other risk factors included soft pancreas texture and low preoperative serum albumin.

Conclusions:

• Dividing the surgeon's workload during pancreaticoduodenectomy (PD) is associated with reduced rates of post-operative pancreatic fistula (POPF).
• Optimizing surgeon involvement and task distribution may be crucial for minimizing POPF after PD.