Pancreaticoduodenectomy in the Middle East: Achieving optimal results through specialization and standardization
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Elsevier (Singapore) Pte Ltd
Abstract
Background: Pancreaticoduodenectomy is a challenging surgical intervention that remains the cornerstone in the treatment of localized peri‑ampullary pathologies. The concept of treatment standardization has been well-established in many high-volume centers in the world. Here, we present our experience in pancreaticoduodenectomy from 1994 to 2015. Methods: We performed a retrospective review of the medical charts of patients who underwent pancreaticoduodenectomy at our institution. Data was entered to SPSS statistical software and analyzed. The Mann–Whitney U and Fisher's exact tests were used to report statistical differences between groups. Results: Of the 370 patients who underwent pacreaticoduodenectomy, 300 were analyzed. The 1-, 3-, 5- and 10-year survival rates were 85%, 35%, 15%, and 7%, respectively with a 30-day mortality rate of 5.0% (15 patients). The median age of the patients was 61 (13–84) years, with 193 (64.3%) males and 107 (35.7%) females. The median operative time was 300 (130–570) min. The median postoperative length of hospital stay was 12 (5–76) days. Thirty-two patients required re-laparotomies; 10 for pancreatic leak, 7 for biliary leak and 15 for control of bleeding. Seventy-five (25.0%) patients developed pancreatic fistulae. Delayed gastric emptying was present in 31 (10.3%) patients. A significant improvement in surgical outcome was observed in cases done after 2008 which indicates the important role of specialized team in surgical management. Conclusions: The number of patients undergoing pancreaticoduodenectomy has been increasing annually over the past twenty-two years in our institution with results comparable to published series from high-volume centers. Through standardization of surgical techniques and perioperative management carried out by a specialist team, our results continue to improve despite the increasing complexity of cases referred to our unit. © 2019 First Affiliated Hospital, Zhejiang University School of Medicine in China
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Middle east, Pancreatic cancer, Pancreaticoduodenectomy, Adolescent, Adult, Aged, Aged, 80 and over, Anastomosis, surgical, Anastomotic leak, Bile ducts, Clinical competence, Digestive system neoplasms, Female, Humans, Length of stay, Male, Middle aged, Neoplasm staging, Operative time, Pancreatic ducts, Pancreatic fistula, Postoperative hemorrhage, Reference standards, Reoperation, Retrospective studies, Specialization, Survival rate, Young adult, Low molecular weight heparin, Piperacillin plus tazobactam, Abdominal abscess, Abdominal pain, Acute kidney failure, Acute pancreatitis, Antibiotic prophylaxis, Article, Bile leakage, Body mass, Cancer survival, Comorbidity, Controlled study, Coronary artery disease, Deep vein thrombosis, Diabetes mellitus, Endoscopic retrograde cholangiopancreatography, Gastrojejunostomy, Heart disease, Hepatojejunostomy, Human, Human tissue, Jaundice, Laparotomy, Major clinical study, Operation duration, Outcome assessment, Pancreas cancer, Pancreas fistula, Pneumonia, Postoperative complication, Retrospective study, Sepsis, Stomach paresis, Surgical infection, Urinary tract infection, Very elderly, Adverse event, Anastomosis, Anastomosis leakage, Bile duct, Cancer staging, Digestive system tumor, Pancreatic duct, Pathology, Standard