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

Abstract

Purpose Many studies have concluded that cancer patients may have better outcomes when their surgery is performed in high-volume centers, especially when the procedure is pancreaticoduodenectomy (PD). 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. Methods I retrospectively collected and analyzed the outcomes of PD for periampullary cancers treated with curative intent in my center. Results From August 2, 2005 to December 10, 2018, 160 pancreatic resections were done with curative intent in my center. The number of operations per year was 1 in 2005 and gradually increased to 21 in 2018. Thirty-day mortality was 0, and 90-day mortality was 1 (0.6%). Morbidity was found in 65 cases (40.6%). The median follow-up period was 23.2 months and 5-year survival rates were 28.5% for pancreas head cancer, 48.2% for distal CBD cancer, and 72.6% for AOV cancer. I divided patients into 2 groups by the number of annual operations, which is more than 21 per 2 years. The 2 groups showed no differences in terms of morbidity and mortality. Conclusion A well-trained low-volume surgeon may perform PD safely at a well-equipped low-volume center.

Improvement in Surgical Quality Following Pancreaticoduodenectomy With Increasing Case Volume in a Rural Hospital

“…While the literature is replete with multi-institutional and national/regional studies comparing outcomes after PD according to annual hospital volumes, very few have attempted to identify similarities and/or differences when assessing a single institution throughout the years of its maturation. 17-19 A study from India retrospectively evaluated 200 patients who underwent PD between 2002 and 2013 and found significantly decreased morbidity, LOS, and mortality for the high-volume period, which was defined as >25 PD/year. 17 Another single-institution study from Sweden evaluated 221 patients who underwent PD from 2000 to 2012 and found significantly decreased reoperation rate and LOS in the high-volume period, which was defined as ≥25 PD/year; however, the decrease in mortality did not reach statistical significance.…”