Kennedy GT, et al. – Researchers here investigated how 4 interpretations of experience [years in practice, surpassing the learning curve (≥50 pancreatoduodenectomies), high annual volume (≥25 pancreatoduodenectomy/year), and high career volume (>200 pancreatoduodenectomy)] influence pancreatoduodenectomy management decisions. They observed that experience encompasses several components, each of which seemed to influence decision making in different ways.

Methods

• 6 surgical societies distributed a survey assessing pancreatoduodenectomy practice patterns.
• 4 forms of behaviors associated with experience were identified with regression analysis: years in practice, surpassing the learning curve (≥50 pancreatoduodenectomies), high annual volume (≥25 pancreatoduodenectomy/year), and high career volume (>200 pancreatoduodenectomy).

Results

• 861 surgeons responded in this study, representing 6 continents.
• Senior surgeons seemed frequently using pancreatogastrostomy, dunking/invagination, and external stents (all P < .05).
• 65% respondents surpassed the learning curve, and these surgeons were more frequently used a 2–layer pancreatic enteric anastomosis, stents, and the Fistula Risk Score (all P < .05).
• High annual volume surgeons seemed using the same reconstruction on every case and autologous tissue patches, but they used less frequently the Roux limb technique and multiple drains (all P < .05).
• High career volume surgeons indicated the behaviors of those surpassing the learning curve except for using the Fistula Risk Score.