Significance of Two Experienced Pancreatic Surgeons Cooperating in Pancreaticoduodenectomies

Aim To investigate if two experienced pancreatic surgeons improves outcome compared to one experienced pancreatic surgeon together with junior assistant. Methods A retrospective analysis of 170 consecutive pancreatoduodenectomies carried out in a four year period was performed. Operation duration, blood loss, complication rate and severity according to Clavien-Dindo score, hospital stay, intensive care unit stay, mortality (in-hospital and 90 day) and oncological completeness (lymph node count and surgical margins) were evaluated separately for patients operated by one or two experienced pancreatic surgeons. Continuous data was analyzed with Mann Whitney U test and categorical data was analyzed with χ2 square test. Results Operations carried out by two pancreatic surgeons (n=99) lasted 290 (111- 613) minutes compared to 353 (195-817) when done by one (n=71) (p<0.001). Moderate to severe complications (≥ grade 3a) were found in 23 (23%) of patients operated by two pancreatic surgeon compared to 28 (39%) of those operated by one (p=0.023). Post-operative pancreatic fistula (POPF) was found in 13 (13%) and 20 (28%) of patients operated by two and one pancreatic surgeons respectively (p=0.014). Patients operated by two experienced surgeons had a total of 39 days (3%) of the total hospital stay (1343 days) in intensive care unit compared to 67 of 990 (7%) in the other group (p<0.01). No difference was found in blood loss, hospital stay, post-operative mortality or oncological completeness. Conclusion Two experienced pancreatic surgeons perform pancreatoduodenectomy faster than does one with less complications and post-operative pancreatic fistula as well as reduced need for intensive care unit stay.