Learning Curve of a Young Surgeon’s Minimal Invasive Pancreatoduodenectomy: A CUSUM Analysis

Introduction: Minimal invasive pancreatoduodenectomy (MIPD) remains an extremely demanding advanced minimal invasive technique and learning curve remains unknown. The purpose of this study was to describe the learning curve of MIPD performed by a surgeon under 40 years of age. Method: The patients who underwent MIPD for periampullary tumor between July 2018 to June 2021 by single surgeon who started MIPD after completing two years of fellowship in high volume institution were retrospectively reviewed. Data for all the patients, including preoperative, intraoperative, and postoperative variables were collected and analyzed. The learning curve for MIPD was evaluated using cumulative summation (CUSUM) analysis for operation time. Results: Among 61 enrolled patients, one operation converted to open surgery (1.6%). Median operation time and postoperative hospital stay were 340 minutes and 9 days. There was no mortality. Postoperative complications occurred in 32 patients (52.5%) and exceeded Clavien-Dindo grade III in 4 patients (6.6%). POPF grade B or C occurred in 6 patients (9.8%). Operation time decreased after 37 operations from a mean of 371 min to 339 min (p=0.066). However, all postoperative factors including complication, hospital stay, readmission rate were not different before and after 37 operations. Conclusions: MIPD can be performed safely even by a young surgeon. Operation time decreased after the 37 operations, but there was no statistically significant reduction on operation time. Other postoperative factors were not clearly improved, and further study is needed about learning curve of MIPD.