Pancreaticoduodenectomy -When, Who?

Satoru Matsusue, Satoru Nishimura and Tsunehiro Yoshimura

Department of Abdominal Surgery, Tenri Hospital

Significant debate exists regarding competence in complex surgery such as pancreaticoduodenectomy (PD) and its suitability for instructing trainees. Hypothesizing that the first conducting of PD by residents are acceptable with favorable outcomes under supervision by experienced surgeons, we studied the medical records of 18 patients undergoing a first PD by senior residents (R group) in a residency program from 1977 to 2007. We also analyzed and compared data from the records of 8 patients undergoing surgery by new staff-surgeons during the same period (S group). Seven supervisors were concerned with the first PD by 18 residents and had conducted PD on 19 patients in median during a 22-year surgical career in median. Perioperative outcome, including operating time, estimated blood loss, postoperative complications and length of hospital stay, did not differ between the two groups. No hospital death occurred in either group and these results compared favorably with better benchmark outcomes. PD conducted under the supervision of experienced surgeons thus appears acceptable and an important curriculum item in surgical residencies.

Key words
pancreaticoduodenectomy, surgical training, residency

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

Accepted
April 22, 2009

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