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HPB (Oxford). 2016 Dec;18(12):965-978. doi: 10.1016/j.hpb.2016.09.008. Epub 2016 Oct 28.

The influence of fellowship training on the practice of pancreatoduodenectomy.

Author information

1
Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
2
Department of Surgery, University of Verona, Verona, Italy.
3
Department of Surgery, University of Toronto, Toronto, Canada.
4
Department of Surgery, Portland Providence Cancer Institute, Portland, OR, USA.
5
Department of Surgery, Methodist Dallas Medical Center, Dallas, TX, USA.
6
Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
7
Department of Surgery, UT Southwestern Medical Center, Dallas, TX, USA.
8
Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA. Electronic address: Charles.Vollmer@uphs.upenn.edu.

Abstract

BACKGROUND:

There has been a proliferation of gastrointestinal surgical fellowships; however, little is known regarding their association with surgical volume and management approaches.

METHODS:

Surveys were distributed to members of GI surgical societies. Responses were evaluated to define relationships between fellowship training and surgical practice with pancreatoduodenectomy (PD).

RESULTS:

Surveys were completed by 889 surgeons, 84.1% of whom had completed fellowship training. Fellowship completion was associated with a primarily HPB or surgical oncology-focused practice (p < 0.001), and greater median annual PD volume (p = 0.030). Transplant and HPB fellowship-trained respondents were more likely to have high-volume (≥20) annual practice (p = 0.005 and 0.029, respectively). Regarding putative fistula mitigation strategies, HPB-trained surgeons were more likely to use stents, biologic sealants, and autologous tissue patches (p = 0.007, <0.001 and 0.001, respectively). Surgical oncology trainees reported greater autologous patch use (p = 0.003). HPB fellowship-trained surgeons were less likely to routinely use intraperitoneal drainage (p = 0.036) but more likely to utilize early (POD ≤ 3) drain amylase values to guide removal (p < 0.001). Finally, HPB fellowship-trained surgeons were more likely to use the Fistula Risk Score in their practice (29 vs. 21%, p = 0.008).

CONCLUSION:

Fellowship training correlated with significant differences in surgeon experience, operative approach, and use of available fistula mitigation strategies for PD.

PMID:
28029534
PMCID:
PMC5144550
DOI:
10.1016/j.hpb.2016.09.008
[Indexed for MEDLINE]
Free PMC Article

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