title: The "Nouvelle Vague" of surgeons in pancreatic surgery: can they rise to the legacy of current surgeons?
abstract: OBJECTIVE
  Pancreatic surgery is still thought as a challenging field even for experienced hepatobilliary (HPB) surgeons and high volume tertiary centers. The purpose of this study was to present the results (mortality and morbidity) of pancreatic surgery in a high volume center, in operations performed solely by inexperienced surgeons (two 6th year residents and a HPB fellow) under the supervision of expert surgeons on the field.
  
  
  METHODS
  Forty-one consecutive patients who underwent curative-intent pancreatic resection with a modified pancreaticojejunostomy between January 2010 and December 2014 at Asklepios Hospital Barmbek, Germany, were identified from our institutional computer-based database. Two 6th year residents and an HPB-fellow performed all pancreatic anastomoses under the instructions of an experienced surgeon. Perioperative outcomes were recorded and analyzed.
  
  
  RESULTS
  Median postoperative length of stay for all patients was 15 days (IQR:7-31). In the first 90 postoperative days, the postoperative mortality rate was 0% and morbidity rate reached 39%. Reoperation was required in 1 patient (2.44%). However, no reoperation was performed for pancreatic anastomotic failure. No postoperative hemorrhage requiring interventional procedure or reoperation occurred in any patient.
  
  
  CONCLUSIONS
  The outcomes of pancreatic surgery performed by less experienced surgeons are satisfactory. The instructions of an expert surgeon in a high volume hospital definitely secures a favorable outcome after pancreatic surgery with lower mortality and morbidity rates compared with current literature trends.
authors.affiliation: Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Hamburg, Germany.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Papalampros
authors.forename: Demetrios
authors.initials: D
authors.lastname: Moris
authors.forename: Mohammad
authors.initials: M
authors.lastname: Fard-Aghaie
authors.forename: Gregor A
authors.initials: GA
authors.lastname: Stavrou
authors.forename: Evangelos
authors.initials: E
authors.lastname: Felekouras
authors.forename: Klaus
authors.initials: K
authors.lastname: Niehaus
authors.forename: Karl
authors.initials: K
authors.lastname: Oldhafer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000209:etiology; D066231:Surgeons