Pancreaticoduodenectomy in a Government Medical College—Should We Proceed!!!

Abstract

The value of standard Pancreaticoduodenectomy for Periampullary carcinomas has long been a matter of debate. Though the mortality has dramatically reduced in high volume centers with dedicated hepatobiliary surgery units, the rate is still high in peripheral institutes. In this study our aim was to access the overall post operative outcome associated with pancreaticoduodenectomy performed in a government medical college. A total of 44 patients who underwent pancreaticoduodenectomy for operable periampullary cancers were evaluated. The overall morbidity rate was 31.1%. A total of 13 (29.5%) died following the operation and of its complications though the rate has reduced drastically to 14.2% in2008. The average length of hospital stay was 22 days. The mean survival was 15 months. Pancreaticoduodenectomy can safely be performed in government medical colleges with good results. In view of the majority of the patients in rural and suburban communities, not all patients need referral to higher centers.

Pancreaticoduodenectomy: Impact of Volume on Outcomes at a Tertiary Care Center—Our Experience in Single Institute of Nepal

“…The incidence of periampullary carcinoma increases with age and most of the patients in our study were in their sixth decade of life which is similar to other previous studies [8]. Male preponderance for the malignant disease has been observed.…”

“…The majority of the study participants presented features of obstructive jaundice which is classical and consistent with all previous studies. Many of the patients (38.6%) also presented with pain abdomen which may be attributable to cholangitis or associated pancreatitis (8). Pain abdomen may also arise because of the tumor itself or the in ltration of the tumor to the retroperitoneal nerves and nerves surrounding the pancreas [9].…”

Outcome of Pancreaticoduodenectomy at Low-Volume Centre in Tier-II City of India

“…Over a period of time with changing trends and experience of the surgeons, the numbers of such major surgical procedures like PD being done in such hospitals are increasing with comparable surgical outcome with high-volume centres. Even though India is a country with low incidence of pancreatic cancer and a disproportionate distribution of resources, the centres with high volumes, standardisation, and service reconfiguration have achieved perioperative outcomes comparable to highincidence developed nations [13,22]. Similarly in this study, we have shared our surgical outcomes of a Tier-II city hospital, which is to any high-volume centre hospital nationwide/worldwide in terms of facilities.…”

Centralisation of Pancreatoduodenectomy in India: Where Do We Stand?

“…Surgeons and primary care physicians also stand to benefit from development of centres of excellence for PD Kaman et al [19] Sunil et al [34] Vinchurkar et al [36] Govil et al [42] Patra et al [10] Singhal et al [13] Shah et al [14] Samaddar et al [17] Kaman et al [18] Jakhmola et al [21] Reddy et al [26] Govil et al [27] Pal et al [28] Mishra et al [31] Tampi et al [32] Krishna et al [35] Pamecha et al [38] Jain et al [39] Chowdappa et al [40] Nikhil et al [43] Gupta et al [44] Ray et al [9] Barreto et al [11] Perwaiz et al [12] Palanivelu et al [16] Kurumboor et al [20] Rammohan et al [22] Sivaraj et al [23] Rajarathinam et al [24] Shrikhande et al [25] Gangavatiker et al [29] Singh et al [30] Mansukhani et al [33] Manipadam et al [37] Tewari et al [ as they can focus more intently on problems that are more commonly encountered in their practice than invest their time in a disease that is infrequent. The surgeons at dedicated units develop better understanding of the disease process, anatomy and anatomic anomalies, thereby achieving more proficiency, and become better equipped to take complex clinical decisions.…”