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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

  • Original article
  • Published:
Journal of Hepato-Biliary-Pancreatic Sciences

Abstract

Background/purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgments

The authors thank Dr. Takukazu Nagakawa (Representative of Japanese Society of Pancreatic Surgery) for helpful suggestions, and 71 members of the Japanese Society of Pancreatic Surgery for their prompt replies to the questionnaires (see “Appendix”).

Author information

Authors and Affiliations

  1. Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan

    Ryuichi Kawahara, Gen Akasu, Hiroto Ishikawa, Masafumi Yasunaga & Hisafumi Kinoshita

Authors
  1. Ryuichi Kawahara
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  2. Gen Akasu
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  3. Hiroto Ishikawa
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  4. Masafumi Yasunaga
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  5. Hisafumi Kinoshita
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Corresponding author

Correspondence to Ryuichi Kawahara.

Appendix

Appendix

Department of Gastroenterological Surgery, Aichi Medical University.

Division of Gastroenterologic and General Surgery, Department of Surgery, Asahikawa Medical University.

Department of Surgery, Murakami Memorial Hospital Asahi University.

Department of Surgery, Ibaraki Prefectural Central Hospital and Cancer Center.

Department of Surgery, Hepato-biliary-pancreatic Surgery and Transplantation, Ehime University Graduate School of Medicine.

Department of Surgery, Oita Red Cross Hospital.

Department of Surgery, Ogaki Municipal Hospital.

Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University.

Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases.

Department of Hepato-biliary-pancreatic Surgery, Osaka City University Graduate School of Medicine.

Department of Surgical Oncology, Osaka City University Graduate School of Medicine.

Department of Gastroenterological Surgery, Kagawa University Hospital.

Department of Surgery, Kagoshima Kouseiren Hospital.

Department of Surgery, Kagoshima Medical Association Hospital.

Department of Surgical Oncology, Kagoshima University Graduate School.

Department of Gastroenterologic Surgery, Kanazawa University Graduate School of Medical Science.

Department of Surgery, Kansai Medical University.

Department of Surgery, Kitakyusyu Municipal Medical Center.

Department of Surgical Oncology, Gifu University School of Medicine.

Department of Gastroenterological Surgery, National Kyushu Cancer Center.

Department of Hepato-Biliary Pancreatic Surgery and Transplantation, Kyoto University Hospital.

Department of Gastroenterological Surgery, Graduate School of Medicine Sciences, Kumamoto University.

Department of Surgery, Kurume University School of Medicine.

Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine.

Department of Digestive Surgery, National Cancer Center Hospital East.

Department of Digestive Surgery, Saitama Medical University International Medical Center.

First Department of Surgery, Sapporo Medical University, Japan.

Department of Surgery, JA Hokkaido-Kouseiren Sapporo-Kosei General Hospital.

Department of Surgery, Jichi Medical University.

Department of gastroenterological and General Surgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital.

Division of Gastroenterological Surgery, Chiba Cancer Center Hospital.

Department of Surgery, Chiba Rosai Hospital.

Department of Surgery, Teikyou University School of Medicine.

Department of Surgery, Tokyo Medical University Hospital.

Department of Surgery, The Jikei University School of Medicine.

Department of Surgery, Aoto Attached Hospital, The Jikei University School of Medicine.

Department of Surgery, Kashiwa Hospital, The Jikei University School of Medicine.

Department of Surgery, Daisan Hospital, The Jikei University School of Medicine.

Department of Surgery, Institute of Gastroenterology Tokyo Women’s Medical University

Department of Surgery, Toho University Ohashi Medical Center.

Department of Surgery, Tochigi Cancer Center.

Department of Surgery, Division of Surgical Oncology, Tottori University Faculty of Medicine.

Department of Surgery, Kyouaikai Tobata Kyouritsu Hospital.

Department of Surgery, National Hospital Organization Nagasaki Medical Center.

Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences.

Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences.

Department of Surgery, Japanese Red Cross Nagoya Daiichi Hospital.

Department of Surgery II, Nagoya Graduate School of Medicine.

Department of Surgery, Nara Medical University.

Department of Surgery, Niigata Prefectural Center Hospital.

Division of Digestive and General Surgery, Niigata University.

Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School.

Department of Surgery, Nippon Koukan Hospital.

Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine.

Second Department of Surgery, Hamamatsu University School of Medicine.

Department of Surgery, Higashiosaka City General Hospital.

Department of Surgery, Hyogo College of Medicine.

Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine.

Department of Surgery, Hiroshima City Hospital.

Department of Surgery, Graduate School of Biomedical Sciences, Hiroshima University.

Department of Surgery, Fukaya Red Cross Hospital.

First Department of Surgery, Faculty of Medicine, University of Fukui.

Department of Surgery, Fukuoka Red Cross Hospital.

Department of Surgery, Fukuyama City Hospital.

Department of Surgery, Fujita Health University School of Medicine.

Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine.

Department of Surgical Oncology and Regulation of Organ Function, Miyazaki University School of Medicine.

Department of Surgery, Meiwa General Hospital.

Department of Gastroenterological Surgery, Yokohama City University.

Second Department of Surgery, Wakayama Medical University.

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Kawahara, R., Akasu, G., Ishikawa, H. et al. 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. J Hepatobiliary Pancreat Sci 20, 173–185 (2013). https://doi.org/10.1007/s00534-012-0505-y

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