What’s the next step in evaluating laparoscopic pancreaticoduodenectomy?

In the open approach, pancreaticoduodenectomy (PD) continues to be a high-risk procedure with a high rate of severe complications and a global death-rate of 9.2% and 10.1% in some developed European countries, such as France and Germany, respectively (1,2). Most of reported volume-based outcome studies have found a strong inverse association between mortality and hospital volume. In a nationwide German hospital discharge data (2), risk-adjusted mortality of very-low-volume vs very-high-volume hospitals was 11.5% vs. 6.5%, respectively.