A preliminary exploration on safety and learning curve of laparoscopic pancreatoduodenectomy in low-flow pancreatic center

Objective To compare the safety of laparoscopic pancreatoduodenectomy (LPD) and open pancreatoduodenectomy (OPD) and analyze the learning curve and safety at different stages of LPD.

Methods A retrospective analysis was conducted on the clinical data of 50 LPD patients and 54 OPD patients in the Department of Hepatopancreatobiliary Surgery of Suzhou Hospital Affiliated to Nanjing Medical University from January 2020 to June 2024, and intraoperative and postoperative conditions were compared. The Cumulative Sum (CUSUM) analysis method was used to analyze the technical nodes of the LPD learning curve.

Results There were no significant differences in operation time and intraoperative blood loss between the LPD group and the OPD group (P>0.05). There was also no significant difference in the incidence rates of pancreatic fistula (grade B and C), delayed gastric emptying, postoperative bleeding, biliary fistula and intra-abdominal infection between the LPD group and the OPD group (P>0.05). A time series plot of operation time was drawn based on the patient's operation time and surgical sequence, yielding a fitted curve. Curve analysis showed initial stage and stable stage were finished at the 17th and 24th cases. The LPD learning curve could be divided into three stages: stage Ⅰ characterized as the initial stage (cases 1 to 17), stage Ⅱ characterized as the stable stage (cases 18 to 24), and stage Ⅲ characterized as the proficient stage (cases 25 to 50). The operation time in stages Ⅱ and Ⅲ was significantly shorter than that in stage Ⅰ, and the intraoperative blood loss in stage Ⅰ was significantly higher than that in stage Ⅲ (P < 0.05). There was no significant difference in the incidence of complications among the three stages (P>0.05).

Conclusion LPD and OPD show no significant differences in indications and safety. The LPD learning curve can be divided into three stages. As the number of surgeries completed increases, the operation time of physicians gradually shortens, and the incidence of complications of patients gradually decreases.