Is there a Learning Curve for Pancreaticoduodenectomy after Fellowship Training?

Background. Limited data exist regarding a learning curve for pancreaticoduodenectomy (PD). This study examines whether a learning curve exists for the performance of PD after fellowship training. Methods. Review of the outcomes of a single surgeon's first 60 PDs after completion of specialty training in pancreatic surgery. Results. Sixty PDs were performed over five years, with the final 30 being done in the last 15 months. Patient age and gender did not differ between the first 30 and last 30 patients. When comparing the first 30 PDs to the second 30 PDs, significant improvements were found in operative time (463 versus 388 minutes), length of stay (10 versus 7 days), and receipt of adjuvant therapy (58% versus 91%). There were no significant differences found in mortality (7% versus 0%), complications (60% versus 50%), readmissions (18% versus 20%), or margin-positive resections (25% versus 24%). Conclusion. Even with extensive training in pancreatic surgery, a learning curve exists for the performance of PD. With experience, improvements were made in operative time, but more importantly in patient outcomes including length of stay and receipt of adjuvant therapy.