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HPB Surgery
Volume 2010 (2010), Article ID 230287, 4 pages
Clinical Study

Is there a Learning Curve for Pancreaticoduodenectomy after Fellowship Training?

Department of Surgery, Division of Surgical Oncology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106-5047, USA

Received 20 September 2010; Accepted 17 December 2010

Academic Editor: Guy Maddern

Copyright © 2010 Jeffrey M. Hardacre. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Limited data exist regarding a learning curve for pancreaticoduodenectomy (PD). This study examines whether a learning curve exists for the performance of PD after fellowship training. Methods. Review of the outcomes of a single surgeon's first 60 PDs after completion of specialty training in pancreatic surgery. Results. Sixty PDs were performed over five years, with the final 30 being done in the last 15 months. Patient age and gender did not differ between the first 30 and last 30 patients. When comparing the first 30 PDs to the second 30 PDs, significant improvements were found in operative time (463 versus 388 minutes), length of stay (10 versus 7 days), and receipt of adjuvant therapy (58% versus 91%). There were no significant differences found in mortality (7% versus 0%), complications (60% versus 50%), readmissions (18% versus 20%), or margin-positive resections (25% versus 24%). Conclusion. Even with extensive training in pancreatic surgery, a learning curve exists for the performance of PD. With experience, improvements were made in operative time, but more importantly in patient outcomes including length of stay and receipt of adjuvant therapy.