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  • Lof, SanneUniv Amsterdam, Netherlands; Canc Ctr Amsterdam, Netherlands; Fondazione Poliambulanza Ist Osped, Italy (author)

Learning Curves of Minimally Invasive Distal Pancreatectomy in Experienced Pancreatic Centers

  • Article/chapterEnglish2023

Publisher, publication year, extent ...

  • AMER MEDICAL ASSOC,2023
  • printrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:liu-197591
  • https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-197591URI
  • https://doi.org/10.1001/jamasurg.2023.2279DOI

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  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • IMPORTANCE Understanding the learning curve of a new complex surgical technique helps to reduce potential patient harm. Current series on the learning curve of minimally invasive distal pancreatectomy (MIDP) are mostly small, single-center series, thus providing limited data. OBJECTIVE To evaluate the length of pooled learning curves of MIDP in experienced centers. DESIGN, SETTING, AND PARTICIPANTS This international, multicenter, retrospective cohort study included MIDP procedures performed from January 1, 2006, through June 30, 2019, in 26 European centers from 8 countries that each performed more than 15 distal pancreatectomies annually, with an overall experience exceeding 50 MIDP procedures. Consecutive patients who underwent elective laparoscopic or robotic distal pancreatectomy for all indications were included. Data were analyzed between September 1, 2021, and May 1, 2022. EXPOSURES The learning curve for MIDP was estimated by pooling data from all centers. MAIN OUTCOMES AND MEASURES The learning curvewas assessed for the primary textbook outcome (TBO), which is a composite measure that reflects optimal outcome, and for surgical mastery. Generalized additive models and a 2-piece linear model with a break point were used to estimate the learning curve length of MIDP. Case mix-expected probabilities were plotted and compared with observed outcomes to assess the association of changing case mix with outcomes. The learning curve also was assessed for the secondary outcomes of operation time, intraoperative blood loss, conversion to open rate, and postoperative pancreatic fistula grade B/C. RESULTS From a total of 2610 MIDP procedures, the learning curve analysis was conducted on 2041 procedures (mean [SD] patient age, 58 [15.3] years; among 2040 with reported sex, 1249 were female [61.2%] and 791 male [38.8%]). The 2-piece model showed an increase and eventually a break point for TBO at 85 procedures (95% CI, 13-157 procedures), with a plateau TBO rate at 70%. The learning-associated loss of TBO rate was estimated at 3.3%. For conversion, a break point was estimated at 40 procedures (95% CI, 11-68 procedures); for operation time, at 56 procedures (95% CI, 35-77 procedures); and for intraoperative blood loss, at 71 procedures (95% CI, 28-114 procedures). For postoperative pancreatic fistula, no break point could be estimated. CONCLUSION AND RELEVANCE In experienced international centers, the learning curve length of MIDP for TBO was considerable with 85 procedures. These findings suggest that although learning curves for conversion, operation time, and intraoperative blood loss are completed earlier, extensive experience may be needed to master the learning curve of MIDP.

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  • Claassen, LindaRadboud Univ Nijmegen, Netherlands (author)
  • Hannink, GerjonRadboud Univ Nijmegen, Netherlands (author)
  • Al-Sarireh, BilalMorriston Hosp, Wales (author)
  • Björnsson, BergthorLinköpings universitet,Avdelningen för kirurgi, ortopedi och onkologi,Medicinska fakulteten,Region Östergötland, Kirurgiska kliniken US(Swepub:liu)berbj34 (author)
  • Boggi, UgoUniv Pisa, Italy (author)
  • Burdio, FernandoHosp Mar, Spain (author)
  • Butturini, GiovanniPederzoli Hosp, Italy (author)
  • Capretti, GiovanniHumanitas Univ, Italy; IRCCS Humanitas Res Hosp, Italy (author)
  • Casadei, RiccardoSt Orsola Marcello Malpighi Hosp, Italy (author)
  • Dokmak, SafiBeaujon Hosp, France (author)
  • Edwin, BjornOslo Univ Hosp, Norway; Oslo Univ Hosp, Norway; Univ Oslo, Norway (author)
  • Esposito, AlessandroVerona Univ Hosp, Italy (author)
  • Fabre, Jean M.St Eloi Hosp, France (author)
  • Ferrari, GiovanniASST Grande Osped Metropolitano Niguarda, Italy (author)
  • Fretland, Asmund A.Oslo Univ Hosp, Norway; Univ Oslo, Norway (author)
  • Fteriche, Fadhel S.Beaujon Hosp, France (author)
  • Fusai, Giuseppe K.Royal Free London NHS Fdn Trust, England (author)
  • Giardino, AlessandroPederzoli Hosp, Italy (author)
  • Groot Koerkamp, BasErasmus MC Canc Inst, Netherlands (author)
  • DHondt, MathieuAZ Groeninge Hosp, Belgium (author)
  • Jah, AsifCambridge Univ Hosp NHS Fdn Trust, England (author)
  • Kamarajah, Sivesh K.Newcastle Tyne Hosp NHS Fdn Trust, England (author)
  • Kauffmann, Emanuele F.Univ Pisa, Italy (author)
  • Keck, TobiasUniv Med Ctr Schleswig Holstein, Germany (author)
  • van Laarhoven, StijnCambridge Univ Hosp NHS Fdn Trust, England (author)
  • Manzoni, AlbertoFondazione Poliambulanza Ist Osped, Italy (author)
  • Marino, Marco V.Azienda Osped Osped Riuniti Villa Sofia, Italy (author)
  • Marudanayagam, RaviUniv Hosp Birmingham NHS Trust, England (author)
  • Molenaar, Izaak Q.Univ Med Ctr Utrecht, Netherlands (author)
  • Pessaux, PatrickNouvel Hop Civil IHU Strasbourg, France (author)
  • Rosso, EdoardoCtr Hosp Luxembourg, Luxembourg (author)
  • Salvia, RobertoVerona Univ Hosp, Italy (author)
  • Soonawalla, ZahirOxford Univ Hosp NHS Fdn Trust, England (author)
  • Souche, RegisSt Eloi Hosp, France (author)
  • White, StevenNewcastle Tyne Hosp NHS Fdn Trust, England (author)
  • van Workum, FransCanisius Wilhelmina Ziekenhuis, Netherlands (author)
  • Zerbi, AlessandroHumanitas Univ, Italy; IRCCS Humanitas Res Hosp, Italy (author)
  • Rosman, CamielRadboud Univ Nijmegen, Netherlands (author)
  • Stommel, Martijn W. J.Radboud Univ Nijmegen, Netherlands (author)
  • Abu Hilal, MohammedFondazione Poliambulanza Ist Osped, Italy; Univ Hosp Southampton NHS Fdn, England (author)
  • Besselink, Marc G.Univ Amsterdam, Netherlands; Canc Ctr Amsterdam, Netherlands (author)
  • Univ Amsterdam, Netherlands; Canc Ctr Amsterdam, Netherlands; Fondazione Poliambulanza Ist Osped, ItalyRadboud Univ Nijmegen, Netherlands (creator_code:org_t)

Related titles

  • In:JAMA Surgery: AMER MEDICAL ASSOC158:9, s. 927-9332168-62542168-6262

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