Achieving Good Perioperative Outcomes After Pancreaticoduodenectomy in a Low-Volume Setting: A 25-Year Experience

Abstract

Perioperative mortality following pancreaticoduodenectomy has improved over time and is lower than 5% in selected high-volume centers. Based on several large literature series on pancreaticoduodenectomy from high-volume centers, some defend that high annual volumes are necessary for good outcomes after pancreaticoduodenectomy. We report here the outcomes of a low annual volume pancreaticoduodenectomy series after incorporating technical expertise from a high-volume center. We included all patients who underwent pancreaticoduodenectomy performed by a single surgeon (ADC.) as treatment for periampullary malignancies from 1981 to 2005. Outcomes of this series were compared to those of 3 high-volume literature series. Additionally, outcomes for first 10 cases in the present series were compared to those of all 37 remaining cases in this series. A total of 47 pancreaticoduodenectomies were performed over a 25-year period. Overall in-hospital mortality was 2 cases (4.3%), and morbidity occurred in 23 patients (48.9%). Both mortality and morbidity were similar to those of each of the three high-volume center comparison series. Comparison of the outcomes for the first 10 to the remaining 37 cases in this series revealed that the latter 37 cases had inferior mortality (20% versus 0%; P = 0.042), less tumor-positive margins (50 versus 13.5%; P = 0.024), less use of intraoperative blood transfusions (90% versus 32.4%; P = 0.003), and tendency to a shorter length of in-hospital stay (20 versus 15.8 days; P = 0.053). Accumulation of surgical experience and incorporation of expertise from high-volume centers may enable achieving satisfactory outcomes after pancreaticoduodenectomy in low-volume settings whenever referral to a high-volume center is limited.

Key drug-targeting genes in pancreatic ductal adenocarcinoma

“…As one of the deadliest types of cancer, PDAC is commonly diagnosed in late stages and is associated with rapid progression and metastasis, resulting in the ASR for 5-year net survival less than 5% [ 5 , 6 , 19 , 20 ]. Due to the lack of effective therapy, cure is seldom considered as a treatment outcome while efforts are mainly intended to prolong the survival of PDAC patients.…”

“…Pancreaticoduodenectomy (Whipple procedure) is commonly adopted to treat tumors from the head of the pancreas; whereas laparoscopic surgery is ideal to treat tumors from the tail of the pancreas [3,4]. Although advances in surgical instruments and techniques have significantly brought down the mortality rate for the pancreaticoduodenectomy procedure, the ASR for 5-year net survival remains less than 5% for PDAC patients [5][6][7].…”

One hundred sixty pancreaticoduodenectomies for periampullary cancers in a growing-volume setting: a single-institution and a single-surgeon's experience

“…And when this concern is focused on performing pancreaticoduodenectomy (PD), which is thought to be a high-risk cancer surgery, the relationship between volume and outcome invariably increased [123456]. However, some studies concluded that experienced surgeons or incorporation of expertise from high-volume centers may achieve satisfactory outcomes after PD in low-volume centers [789].…”