A questionnaire on the educational system for pancreatoduodenectomy performed in 1,134 patients in 71 institutions as members of the Japanese Society of Pancreatic Surgery

Abstract

Mastering the technique of pancreaticoduodenectomy (PD) is a major theme in hepato-biliary-pancreatic surgery, and education for PD has not been established even in each institution. With the progression of disease, the difficulty of PD increases due to cases requiring resection of multiple organs and borderline resectable cases, and complications affecting survival also often occur. To help to improve the education of young surgeons, we clarified the institutions' principles and the status of operations performed by young surgeons. We sent questionnaires to institutions as members of the Japanese Society of Pancreatic Surgery about the institutions' educational principles in 2010 and surgeons who performed PD and patients treated by PD between January and December 2007. The PD operators were classified into two groups: postgraduate year ≤ 10 or ≥ 11, and each institution's principles, and pre-, intra-, and postoperative factors were evaluated. PD was performed by surgeons at postgraduate year ≤ 10 in 29 (40.6%) institutions. Education programs were using 29 (41.4%) institutions. High-volume centers, where the surgeons performing PD tend to be at postgraduate year ≤ 10, can provide more training. Preoperative risks were not included in the criteria for selecting cases for operations by young surgeons, and young surgeons tended to perform PD in patients with less advanced stages. The incidence of pancreatic fistula classified as International Study Group of Pancreatic Surgery Grade B or C was significantly higher (P = 0.010) in the operator group at postgraduate year ≤ 10 (24.6%, 32 patients) than that at postgraduate year ≥ 11 (17.6%, 177 patients). Cumulative survival rate of pancreatic cancer or extrahepatic bile duct cancer did not significantly differ between the two operator groups. The present questionnaire showed increased opportunities of performing operations by young surgeons. Although the incidence of Grade B/C fistula is higher for postgraduate year ≤ 10, postoperative outcome is acceptable. It is acceptable for the pancreaticoduodenectomy performed by young surgeons, when young surgeons receive high-level education under the guidance of supervisory doctor. Prognosis did not differ between two operator groups at postgraduate year ≤ 10 and ≥ 11 in this study. Based on these findings, operations by surgeons at postgraduate year ≤ 10 present can be recommended.