Learning Curve Effect in Reducing Local Recurrence Rate After Resection of Pancreatic Cancer With Arterial Abutment: A Single‐Center Retrospective Study

TL;DR

This study shows that the local recurrence rate after complex pancreatic cancer surgery decreases as surgeons gain experience, suggesting the importance of performing such surgeries at high-volume centers.

Contribution

The study identifies a learning curve effect in reducing local recurrence rates after pancreatic cancer surgery with arterial abutment.

Findings

Local recurrence rate dropped from 70% in the first 10 cases to 10% in the last 10 cases.

Operative period was an independent risk factor for local recurrence, with lower rates observed in later cases.

Abstract

Pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) with arterial abutment is a complex, high‐risk surgery. We aimed to investigate the clinicopathological features, risk factors, and learning curve for local recurrence after pancreatectomy for PDAC with arterial abutment.

Sixty consecutive patients who underwent pancreatectomy for borderline resectable and locally advanced PDAC with arterial abutment at Kobe University Hospital between 2010 and 2020 were enrolled in this retrospective study. Logistic regression analysis was performed to investigate the risk factors for local recurrence. The local recurrence rate was examined for every 10 cases over time.

Eighteen (30.0%) patients developed local recurrence; 12 (20.0%) developed local‐only recurrence, and six (10.0%) developed local and other recurrences. The median survival time after surgery was similar between patients with local‐only (n = 12) and other recurrences (n = 31) (18.9 vs. 17.3 months, p = 0.650). The local recurrence rate was significantly lower during the late period than during the early period (13.3% vs. 46.7%, respectively). In the multivariate analyses, the operative period (odds ratio, 7.01; 95% CI: 1.09–45.2; p = 0.041) was the independent factor associated with local recurrence. The local recurrence rate in the first 10 patients was 70%, but it gradually decreased to 10% in the last 10 patients.

Local recurrence has a significant impact on survival, as do other recurrences after pancreatectomy for PDAC with arterial abutment. A learning curve may exist for the local recurrence rate, suggesting that it should be performed by experienced surgical teams at high‐volume centers.

In a retrospective series of 60 consecutive resections for borderline‐resectable/locally advanced PDAC with arterial abutment, local recurrence rate decreased from 70% in the first 10 cases to 10% in the most recent 10. A learning curve may exist for the local recurrence rate after such surgery, suggesting that it should be performed at high‐volume centers.

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