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

NIU Weiqiao; ZHANG Cong; JIANG Hanlin; HUANG Lining; LU Yijie; XU Yaopeng; LIU Biren; JIANG Xinwei; WU Jianwu

doi:10.7619/jcmp.20245603

Journal of Clinical Medicine in Practice > 2025 > 29(7): 13-18, 25. > DOI: 10.7619/jcmp.20245603

NIU Weiqiao, ZHANG Cong, JIANG Hanlin, HUANG Lining, LU Yijie, XU Yaopeng, LIU Biren, JIANG Xinwei, WU Jianwu. A preliminary exploration on safety and learning curve of laparoscopic pancreatoduodenectomy in low-flow pancreatic center[J]. Journal of Clinical Medicine in Practice, 2025, 29(7): 13-18, 25. DOI: 10.7619/jcmp.20245603

Citation:

PDF (2707 KB)

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

Department of Hepatopancreatobiliary Surgery, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou, Jiangsu, 215000

More Information

Received Date: November 14, 2024
Revised Date: December 25, 2024

Graphical Abstract

Abstract

Abstract

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.
- pancreatoduodenectomy,
- laparoscopy,
- learning curve,
- operation time,
- pancreatic tumor,
- complications,
- Cumulative Sum analysis,
- fitted curve

FullText(HTML)

References (24)

References

[1]	ASBUN H J, MOEKOTTE A L, VISSERS F L, et al. The Miami international evidence-based guidelines on minimally invasive pancreas resection[J]. Ann Surg, 2020, 271(1): 1-14. doi: 10.1097/SLA.0000000000003590
[2]	GAGNER M, POMP A. Laparoscopic pylorus-preserving pancreatoduodenectomy[J]. Surg Endosc, 1994, 8(5): 408-410. doi: 10.1007/BF00642443
[3]	成伟. 从青年医生视角看中国腹腔镜胰十二指肠切除术发展历程[J]. 中国实用外科杂志, 2019, 39(7): 751-752.
[4]	WANG M, PENG B, LIU J H, et al. Practice patterns and perioperative outcomes of laparoscopic pancreaticoduodenectomy in China: a retrospective multicenter analysis of 1029 patients[J]. Ann Surg, 2021, 273(1): 145-153. doi: 10.1097/SLA.0000000000003190
[5]	TORPHY R J, FRIEDMAN C, HALPERN A, et al. Comparing short-term and oncologic outcomes of minimally invasive versus open pancreaticoduodenectomy across low and high volume centers[J]. Ann Surg, 2019, 270(6): 1147-1155. doi: 10.1097/SLA.0000000000002810
[6]	梁马可, 李学民, 梁占强, 等. 学习曲线期腹腔镜下胰十二指肠切除术体会[J]. 肝胆胰外科杂志, 2022, 34(2): 93-97, 103.
[7]	满泉, 庞慧芳, 郭雅明, 等. 低流量医院行"全腹腔镜下胰十二指肠切除术" 临床研究[J]. 国际生物医学工程杂志, 2021, 44(4): 313-317. doi: 10.3760/cma.j.cn121382-20210201-00411
[8]	于洪武, 张芸, 代伟, 等. 基层医院腹腔镜胰十二指肠切除术的学习曲线[J]. 肝胆胰外科杂志, 2021, 33(4): 240-242.
[9]	张财明, 张法标, 杜学峰, 等. 借合作之力开创地市级医院LPD之路[J]. 肝胆胰外科杂志, 2022, 34(8): 465-468.
[10]	刘志强, 周晨, 周颖珂, 等. 基于倾向性评分匹配分析腹腔镜胰十二指肠切除术安全性及其学习曲线: 一项高流量中心回顾性队列研究[J]. 中国实用外科杂志, 2023, 43(10): 1166-1170, 1175.
[11]	吴昊钧, 陈利平, 马文杰, 等. 缩短腹腔镜胰十二指肠切除术学习曲线的初步经验体会[J]. 腹腔镜外科杂志, 2022, 27(5): 337-343.
[12]	赵玉沛. 胰十二指肠切除术现状与展望[J]. 中国实用外科杂志, 2016, 36(8): 817-820.
[13]	KIM H, CHOI H Z, KANG B M, et al. Learning curve in laparoscopic pancreaticoduodenectomy: using risk-adjusted cumulative summation methods[J]. J Laparoendosc Adv Surg Tech A, 2022, 32(4): 401-407. doi: 10.1089/lap.2021.0260
[14]	QIN R Y, KENDRICK M L, WOLFGANG C L, et al. International expert consensus on laparoscopic pancreaticoduodenectomy[J]. Hepatobiliary Surg Nutr, 2020, 9(4): 464-483. doi: 10.21037/hbsn-20-446
[15]	张智勇, 常虎林, 海军, 等. 腹腔镜胰十二指肠切除术的临床应用: 附22例报告[J]. 中国普通外科杂志, 2019, 28(9): 1075-1081.
[16]	HONG S S, CHONG J U, HWANG H K, et al. Laparoscopic pancreaticoduodenectomy reduces incidence of clinically relevant postoperative pancreatic fistula in soft pancreas with a smaller than 2 mm pancreatic duct[J]. Surg Endosc, 2021, 35(12): 7094-7103. doi: 10.1007/s00464-020-08226-8
[17]	牟一平, 金巍巍. 腹腔镜胰十二指肠切除术的现状与展望[J]. 中华外科杂志, 2013, 51(4): 301-303.
[18]	陈立新, 戴梦华. 胰头癌行腹腔镜胰十二指肠切除术的争议与共识[J]. 中国实用外科杂志, 2022, 42(5): 503-506.
[19]	柳弼仁, 许耀鹏, 章聪, 等. 改良胰肠吻合法联合大网膜铺垫技术在胰十二指肠切除术中的应用[J]. 肝胆胰外科杂志, 2023, 35(10): 582-585.
[20]	冯建涛, 陈达伟, 汤晓东, 等. 改良Blumgart胰肠吻合在胰十二指肠切除术中的应用[J]. 中国普通外科杂志, 2022, 31(10): 1395-1401.
[21]	黄小兵, 贺永刚, 唐艺宸, 等. 胰管包裹式胰肠吻合法在腹腔镜胰十二指肠切除术中的应用价值: 附132例分析[J]. 中国普外基础与临床杂志, 2022, 29(10): 1261-1265.
[22]	LI Y, LIANG Y, DENG Y, et al. Application of omental interposition to reduce pancreatic fistula and related complications in pancreaticoduodenectomy: a propensity score-matched study[J]. World J Gastrointest Surg, 2022, 14(5): 482-493. http://qikan.cqvip.com/Qikan/Article/Detail?id=7107333871
[23]	贺卓, 王进峰, 罗建红, 等. 胰十二指肠切除术150例围手术期并发症临床分析[J]. 中国普通外科杂志, 2021, 30(3): 357-364.
[24]	王宏伟, 李杨, 邓尧, 等. 应用大网膜衬垫技术预防腹腔镜胰十二指肠切除术后胰瘘及相关并发症研究[J]. 中国实用外科杂志, 2022, 42(8): 900-905.

Cited By

Cited by

Periodical cited type(15)

1.	高淑彦，赵瑞芳，李文静，刘倩楠，沈青青. 阿托伐他汀钙联合环磷腺苷与托拉塞米治疗老年慢性心功能不全的疗效及对血清BNP、Gal-3、sICAM-1水平的影响. 临床和实验医学杂志. 2025(01): 5-9 .
2.	谢兆莉，张耀堂，苏书艳. 环磷腺苷葡胺联合新四联方案治疗慢性心力衰竭的疗效及对心功能指标的影响. 临床合理用药. 2025(08): 16-19 .
3.	田茂婷，朱应华. 沙库巴曲缬沙坦联合环磷腺苷葡胺对老年慢性心力衰竭患者心率变异性及心功能的影响. 中外医疗. 2024(03): 104-107 .
4.	李树云，刘爱环，郝玲. 卡托普利与左西孟旦共同治疗慢性心力衰竭的效果. 慢性病学杂志. 2024(05): 755-758 .
5.	王坤，孔令才，许林艳，王磊. 心脉隆注射液联合环磷腺苷葡胺治疗高龄慢性心力衰竭效果分析. 世界复合医学(中英文). 2024(02): 9-12 .
6.	王斌. 注射用环磷腺苷葡胺联合复窦合剂对急性心肌梗死后心律失常的应用效果及对QRS波时限、左室射血分数水平影响. 中华养生保健. 2024(16): 53-56 .
7.	葛梦芸. 氧化樟脑注射液联合环磷腺苷葡胺治疗心力衰竭的临床疗效分析. 北方药学. 2024(11): 149-151 .
8.	应璇，贾彩乐，何好权，陈舒，刘俊. 麝香通心滴丸联合沙库巴曲缬沙坦对慢性心力衰竭患者的临床疗效观察. 浙江医学. 2023(06): 617-620 .
9.	窦东锋，刘洪光，张丽芬. 单硝酸异山梨酯联合培哚普利叔丁胺治疗老年慢性心力衰竭患者的疗效. 国际医药卫生导报. 2023(09): 1276-1280 .
10.	赵智慧，宋雨，吴东彬，王娇娇. 冠心宁联合单硝酸异山梨酯治疗慢性心力衰竭患者临床疗效及对心功能的影响. 药学研究. 2023(05): 348-351 .
11.	祖建杰. 卡维地洛联合硝酸异山梨酯在治疗重症心力衰竭中的疗效及其对血清CXCL10和CXCL12水平的影响. 检验医学与临床. 2023(20): 3033-3036 .
12.	刘长英. 左西孟旦与环磷腺苷葡胺联合治疗顽固性心力衰竭的临床观察. 大医生. 2023(22): 56-58 .
13.	郭城楠. 慢性心力衰竭药物治疗临床研究进展. 天津药学. 2022(04): 64-69 .
14.	韩勇，郭艳涛. 单硝酸异山梨酯联合培哚普利叔丁胺治疗慢性心力衰竭的疗效. 深圳中西医结合杂志. 2022(15): 96-99 .
15.	朱明. 环磷腺苷葡胺对老年慢性心力衰竭治疗效果. 现代诊断与治疗. 2022(23): 3533-3536 .

Other cited types(2)

Get Citation

PDF

XML

Article views PDF downloads Cited by(17)

Turn off MathJax

Article Contents

Abstract

References

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

Abstract

References

Cited by

Periodical cited type(15)

Other cited types(2)

Catalog

Export File

Citation

Format

Content