Initial operative experience with pancreaticoduodenectomy after fellowship training
Initial operative experience with pancreaticoduodenectomy after fellowship training
Aim: Pancreaticoduodenectomy is a challenging procedure used primarily for the treatment of pancreatic head cancers. The aimof this study was to share early outcomes of the first pancreaticoduodenectomy operations performed by our surgery team aftercompleting a gastroenterological surgery and surgical oncology fellowship program.Material and Methods: Patients who underwent pancreaticoduodenectomy by the same surgical team between November 2015and August 2018 were retrospectively analyzed. The patients’ demographic data, diagnoses, tumor characteristics, postoperativecomplications, mortality, and clinical findings during follow-up were recorded.Results: A total of 35 patients (21 men and 14 women) with a mean age of 65.6±18.1 years were included in the study. Mean lengthof hospital stay was 16.8±7.3 days. Postoperative pancreatic fistula was observed in 5 patients. Postoperative hemorrhage occurredin 3 patients and delayed gastric emptying (DGE) in 2 patients. Three patients died in the early postoperative period. Mean follow-uptime of the remaining 32 patients was 22.9±8.4 months.Conclusion: Our experience demonstrates that pancreaticoduodenectomy can be performed with acceptable outcomes afterfellowship training that includes pancreatic surgery.
___
- 1. Kausch W. Das Carcinom der Papilla duodeni und seine
radikale Entfernung. Beitr Z Clin Chir 1912;78:439-86.
- 2. Whipple AO, Parsons WB, Mullins CR. Treatment of carcinoma
of the ampulla of Vater. Ann Surg 1935;102:763-79.
- 3. Crile G Jr. The advantages of bypass operations over radical
pancreaticoduodenectomy in the treatment of pancreatic
carcinoma. Surg Gynecol Obstet 1970;130:1049-53.
- 4. Rios G, Conrad A, Cole D, et al. Trends in indications and
outcomes in the Whipple procedure over a 40-year period.
Am Surg 1999;65:889-93.
- 5. Balcom JH, Rattner DW, Warshaw AL, et al. Ten-year
experience with 733 pancreatic resections: changing
indications, older patients, and decreasing length of
hospitalization. Arc Surg 2001;136:391-8.
- 6. Aranha GV, Hodul PJ, Creech S, et al. Zero mortality
after 152 consecutive pancreaticoduodenectomies with
pancreaticogastrostomy. J Am Coll Surg 2003;197:223-32.
- 7. Schmidt CM, Powell ES, Yiannoutsos CT, et al.
Pancreaticoduodenectomy A 20-Year experience in 516
patients. Arc Surg 2004;139:718-27.
- 8. Gouma DJ, van Geenen RC, van Gulik TM, et al. Rates of
complications and death after pancreaticoduodenectomy:
risk factors and the impact of hospital volume. Ann Surg
2000;232:786-95.
- 9. Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update
of the International Study Group (ISGPS) definition and
grading of postoperative pancreatic fistula: 11 years after.
Surgery 2017;161:584-91.
- 10. Cameron JL, Riall TS, Coleman J, et al. One thousand
consecutive pancreaticoduodenectomies. Ann Surg
2006;244:10-5.
- 11. Luft HS, Bunker JP, Enthoven AC. Should operations be
regionalized? The empirical relation between surgical
volume and mortality. N Engl J Med 1979;301:1364-9.
- 12. Balzano G, Zerbi A, Capretti G, et al. Effect of hospital volume
on outcome of pancreaticoduodenectomy in Italy. Br J Surg
2008;95:357-62.
- 13. Birkmeyer JD, Finlayson SR, Tosteson AN, et al. Effect
of hospital volume on in-hospital mortality with
pancreaticoduodenectomy. Surgery 1999;125:250-6.
- 14. Lillemoe KD, Rikkers LF. Pancreaticoduodenectomy the
golden era. Ann Surg 2006;244:16-7.
- 15. Schell MT, Barcia A, Spitzer AL, et al.
Pancreaticoduodenectomy: volume is not associated with
outcome within an academic health care system. HPB Surg
2008;2008:825940.
- 16. Metreveli RE, Sahm K, Abdel-Misih R, et al. Major pancreatic
resections for suspected cancer in a communitybased
teaching hospital: lessons learned. J Surg Oncol
2007;95:201-6.
- 17. Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty
consecutive pancreaticoduodenectomies in the 1990’s:
pathology, complications, and outcomes. Ann Surg
1997;226:248-60.
- 18. Lowy AM, Lee JE, Pisters PW, et al. Prospective, randomized
trial of octreotide to prevent pancreatic fistula after
pancreaticoduodenectomy for malignant disease. Ann Surg
1997;226:632-41.
- 19. Lermite E, Pessaux P, Brehant O, et al. Risk factors of
pancreatic fistula and delayed gastric emptying after
pancreaticoduodenectomy with pancreaticogastrostomy. J
Am Coll Surg 2007;204:588-96.
- 20. van Berge Henegouwen MI, van Gulik TM, DeWit
LT, et al. Delayed gastric emptying after standard
pancreaticoduodenectomy versus pylorus-preserving
pancreaticoduodenectomy: an analysis of 200 consecutive
patients. J Am Coll Surg 1997;185:373-9.
- 21. Horstmann O, Markus PM, Ghadimi MB, et al. Pylorus
preservation has no impact on delayed gastric emptying
after pancreatic head resection. Pancreas 2004;28:69-74.
- 22. Delcore R, Rodriguez FJ, Forster J, et al. Significance of
lymph node metastases in patients with pancreatic cancer
undergoing curative resection. Am J Surg 1996;172:463-8.
- 23. Bakaeen FG, Murr MM, Sarr MG, et al. What prognostic
factors are important in duodenal adenocarcinoma? Arch
Surg 2000;135:635-42.