Pancreaticoduodenectomy Procedure - A Tertiary Care Centre Experience

Abstract

Background: Pancreaticoduodenectomy, also referred to as Whipple's resection, refers to the en bloc surgical resection of the pancreatic head, uncinate process, duodenum, gall bladder, and common bile duct. Though generally done for oncologic indications, the procedure can be warranted in benign or pre-neoplastic conditions of the peri-ampullary region also. Pathologic assessment of surgical specimens from pancreaticoduodenectomy needs special attention in order to accurately evaluate many factors that are prognostically important. The objective of the study was to analyze the clinical as well as histopathological profile of patients who underwent Whipple's resection over a 3-year period at a tertiary level institution. Methods: This descriptive study included patients from the General Surgery and Surgical Gastroenterology wards of Medical College Trivandrum, who underwent pancreaticoduodenectomy from January 2012 to January 2015. Results: The mean age was 55.18 years, with the majority of patients being females. Jaundice was the most common symptom, followed by itching. Among tumour markers, CA 19-9 was elevated in majority of patients, followed by CEA. Majority of the patients underwent PPPD rather than classical Whipple's resection. Head of the pancreas was the most common primary site followed by bile duct, ampulla of Vater and duodenum respectively. Adenocarcinoma was the most common pathological type among all sites with the majority being well-differentiated tumours. Conclusion: Adenocarcinoma of the head of the pancreas is the most common tumour for which majority of the patients undergoes pancreaticoduodenectomy at this institution. Majority of surgeons prefer the pylorus preserving type over the classical Whipple's procedure.