Is Pancreaticoduodenectomy Reasonable as an Educational Goal in the Early Phase of Gastrointestinal Surgical Training?

Satoru Matsusue, Yoshinori Nakamura and Satoru Nishimura

Department of Abdomial Surgery, Tenri Hospital

Pancreaticoduodenectomy (PD) is an operation that requires surgeons to learn the skills and the perioperative care of the entire field of abdominal surgery. We carried our this retrospective study to evaluate the adequacy of making PD an educational goal in the early phase of surgical training, We reviewed the medical recods of patients on whom 13 surgical trainees had performed PD under close supervision by senior surgeons between 1975 and 1998, and we compared the clinical course of the patients with that of patients operated on by leading surgeons during same period and whose characteristics matched the subjects (controls). There were 5 pancreatic cancers, 2 carcinomas of the papilla of Vater, one carcinoid tumor of the pancreas, and 5 carcinomas of the bile duct in the subject group. The operations which the trainees had performed before PD included 57 gastrectomies (median), 15 total gastrectomies, 20 colectomies, 13 rectal resections, 52 cholecystectomies, 15 biliary diversions, and 3 distal pancreatectomies, for 36 (median, range; 19-53) months. There was a significant difference in operative time between two groups (trainees, 521.1±122.5 (mean±SD) min. vs. control, 414.6±74.6 min., p=0.01), but no difference in other items, including postoperative morbidity and mortality. The results of this study indicate that PD may be an appropriate educational goal in a general surgical training in a high case-volume setting with leading experts and a multidisciplinary team support system.

Key words
surgical training, postgraduate education, surgical practice, pancreaticoduodenectomy, educational gaol

Reprint requests
Satoru Matsusue Department of Abdomial Surgery, Tenri Hospital 200 Mishima, Tenri-City, 632-8552 JAPAN

Accepted
March 22, 2000

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