Defining the practice of pancreatoduodenectomy around the world

Abstract

Globally, there is significant variability in the practice of PD. Many of these choices contrast with established randomized evidence and may contribute to variance in outcomes.

Pancreatoduodenectomy: Brazilian practice patterns

“…Thereafter, the surgeon achieves a better postoperative outcome, including reduced operative time and duration of hospital stay 11,28,38 . In the current study, 38 surgeons (73.0%) performed ≥50 PDs, but only 12 surgeons (28.8%) performed >20 PDs last year, defined as high volume.…”

“…Placement of stents into the pancreatic duct is intended to improve the outflow of pancreatic juice during the early period after pancreatojejunostomy and reduce pancreatic fistula. The other indication is for a more precise placement of sutures during pancreatic anastomosis 28,30 . In the current study, 26 surgeons (50%) preferred internal stenting during pancreatic anastomosis, two surgeons (3.9%) performed external stenting, and 24 surgeons (46.1%) never use a stent.…”

“…The procedure requires a high level of experience and standards with regard to technical aspects as well as perioperative care. Minimization of surgery-related mortality and morbidity is imperative, and an important feature of highquality standard surgery 9,28,38 . Centralization of highly complex surgery has been discussed extensively during the past decade and in pancreatic resection has been associated with a decrease in hospital mortality and costs.…”

Why the Resistance: Minimally Invasive Pancreaticoduodenectomy—Saving the Patient from Tigers

“…With half of them having career total volume less than the number of PDs recommended for learning curve. There is a contrast between Bthe practicedâ nd Bthe preached^vis a vis oft touted and established randomized evidence [23]. Pancreatic resection, whether in PD or MIPD revolves around a structured, stepwise charting in the surgical tiger country.…”

“…The general surgeon who adopted MIS incrementally into his repertoire from cholecystectomy -ventral hernias -inguinal hernias -solid organ removal -gastrointestinal resection/anastomosis, is not only adequately skilled for MIPD, but also psychologically equipped for the surgical surprises over the long haul of MIPD. The general surgeon in his forties or fifties (the median age of global PD surgeon being 45 year) [23] started out with the bandwagon of MIS in late 1980 or early 1990s. He is not only skilled to navigate MIPD march but also able shouldered to hold the BMother Church^of surgical disciplines i.e.…”