Risk factors of reoperation after laparoscopic pancreaticoduodenectomy: insight from a learning curve analysis

Reoperation is a serious adverse event after laparoscopic pancreatoduodenectomy (LPD). This study aims to identify risk factors of reoperation after LPD and evaluated the impact of the learning curve. Patients undergoing LPD from February 2014 to May 2024 were retrospectively reviewed. A logistic regression analysis was performed to identify predictors of unplanned reoperations within 90 days. Learning curve analysis was performed to compare surgical outcomes across different stages. Of the 445 patients undergoing LPD, 33 (7.4%) required unplanned reoperation within 90 days. Univariable and multivariable analysis identified prolonged operative time (OR 1.325, 95% CI 1.060-1.670; p = 0.015), intraoperative blood transfusion (OR 2.764, 95% CI 1.049-6.717; p = 0.030), and non-pancreatic ductal adenocarcinoma (PDAC) pathology (OR 2.432, 95%CI 1.120-5.461; p = 0.027) as independent risk factors, while pylorus preservation was protective (OR 0.362, 95%CI 0.151-0.895; p = 0.024) for reoperation after LPD. Learning curve analysis revealed reoperation rates significantly decreased from stage I (20.0%) to the later learning stages (Stage II: 20.0% vs. 5.0%, p = 0.014; Stage III: 20.0% vs. 6.4%, p = 0.006). Prolonged operative time, transfusion, and non-PDAC pathology increased reoperation risk, whereas pylorus preservation was protective. Most reoperations occurred early in the learning curve, with rates decreasing as surgical proficiency improved.