Retrospective analyses of trends in pancreatic surgery: indications, operative techniques, and postoperative outcome of 1,120 pancreatic resections

Abstract

BackgroundHospital volume, surgeons’ experience, and adequate management of complications are factors that contribute to a better outcome after pancreatic resections. The aim of our study was to analyze trends in indications, surgical techniques, and postoperative outcome in more than 1,100 pancreatic resections.MethodsOne thousand one hundred twenty pancreatic resections were performed since 1994. The vast majority of operations were performed by three surgeons. Perioperative data were documented in a pancreatic database. For the purpose of our analysis, the study period was sub-classified into three periods (A 1994 to 2001/n = 363; B 2001 to 2006/n = 305; C since 2007 to 2012/n = 452).ResultsThe median patient age increased from 51 (A) to 65 years (C; P < 0.001). Indications for surgery were pancreatic/periampullary cancer (49%), chronic pancreatitis (CP; 33%), and various other lesions (18%). About two thirds of the operations were pylorus-preserving pancreaticoduodenectomies. The frequency of mesenterico-portal vein resections increased from 8% (A) to 20% (C; P < 0.01). The overall mortality was 2.4% and comparable in all three periods (2.8%, 2.0%, 2.4%; P = 0.8). Overall complication rates increased from 42% (A) to 56% (C; P < 0.01).ConclusionsMortality remained low despite a more aggressive surgical approach to pancreatic disease. An increased overall morbidity may be explained by more clinically relevant pancreatic fistulas and better documentation.

Is Moxifloxacin a Treatment Option for Pancreatic Infections? A Pharmacometric Analysis of Serum and Pancreatic Juice

“…The rate and type of observed complications in the present study were comparable to average long‐term observational studies . Similar to earlier reports, in a substantial number of patients after bile duct stenting, bile was infected and bacterial strains were not restricted to gut‐associated strains .…”

“…24 The rate and type of observed complications in the present study were comparable to average long-term observational studies. 25 Similar to earlier reports, in a substantial number of patients after bile duct stenting, bile was infected and bacterial strains were not restricted to gut-associated strains. 26 These bacterial contaminations not only increased the risk for cholangitis, but apparently even increased perioperative complications such as postoperative pancreatic fistulas, the main factor for perioperative morbidity after pancreatoduodenectomy.…”

Outcomes associated with robotic approach to pancreatic resections

“…Pancreatic cancer remains one of the leading causes of cancer death worldwide (1). Surgical resection is a mainstay of many gastrointestinal (GI) cancers, but pancreatic surgery has significant morbidity and mortality (2). Much improvement has been achieved in minimizing mortality but pancreatic surgery remains one of the most morbid procedures (2).…”

The extent of vascular resection is associated with perioperative outcome in patients undergoing pancreaticoduodenectomy

“…As safety profiles for PD have improved and the potential for long term disease free survival become more well established, pancreaticoduodenectomy with segmental resection of the porto-mesenteric venous system (PDVR) has become increasingly utilized in attempt to achieve margin-negative resection in patients with these tumors. 3,4 Many studies have examined the safety and efficacy of PDVR but the results of these studies have been mixed. Several single institutional studies as well as multicenter studies have found comparable postoperative morbidity rates for patients undergoing PDVR compared to PD alone.…”