Assessment of the learning curve for pancreaticoduodenectomy

Background: Experience with the Whipple procedure has been associated with improved outcomes, but the learning curve for this complex procedure is not well defined. Methods: Outcomes with 162 consecutive Whipple procedures during the 1st 11.5 years of practice was documented in a prospective database. A period of low (≤11/y) and high (<23/y) case volume was compared using the Wilcoxon rank-sum test and Fisher exact test. Results: With low case volume, blood loss was higher (800 vs 400 mL, P =.001), more patients were transfused (44% vs 18%, P =.027), there were more complications (58% vs 46%, P =.0337), and a longer length of stay (10 vs 7 days, P =.006). There was only 1 mortality (.7%). Conclusions: Frequent repetition of the Whipple procedure is associated with an improvement in quantifiable quality benchmarks, and improvement continues with extensive experience. However, with proper training and the right environment, this procedure can be performed during the learning curve with acceptable outcomes.