Feasibility of Pancreaticoduodenectomy in a Nonuniversity Tertiary Care Center: What Are the Key Elements of Success?

Abstract

It is advocated that a favorable outcome for pancreaticoduodenectomy (PD) is related to a high volume at university centers. This article examines the specific elements that allow an equivalent outcome from PD in a nonuniversity tertiary care center (NUTCC). The study was performed to: 1) evaluate the outcome of PDs done at a NUTCC; 2) study the components of the process that are required to attain success in a NUTCC; and 3) provide a new look at the volume-outcome relationships in complex surgeries in a novel nonuniversity setting. Medical records of patients who underwent PD by a single surgeon between September 2005 and August 2008 at a high-volume NUTCC were analyzed. The records were reviewed with respect to preoperative and postoperative data, 30-day mortality, morbidity, and histopathology data. A total of 122 patients underwent PD. The mean age was 68.2 years. Jaundice was the most common presenting symptom in 57 per cent (69 patients). Thirty-nine patients (32%) underwent a pylorus-preserving PD. The mean operative time was 237 minutes. The mean estimated blood loss was 480 mL. The mean length hospital stay was 13 days. Thirty-day mortality was 3.2 per cent (four patients) and overall morbidity was 49 per cent. The key factors in developing a team dedicated to the care of the patient undergoing PD are discussed. A center of excellence can be developed in a NUTCC resulting in outcomes that meet and indeed may exceed nationally reported benchmarks. The key elements to success include a team approach to the patient undergoing PD.

Time trends in the treatment and prognosis of resectable pancreatic cancer in a large tertiary referral centre

“…For patients with localized disease, the improvement in survival parallels that seen in high‐volume centres. Several studies have correlated perioperative outcomes with hospital volume of pancreatic surgeries, demonstrating that pancreatectomy performed at a high‐volume centre improves outcomes as measured by perioperative mortality and hospital length of stay (LoS) . Other experiences have demonstrated the correlation of hospital volume with longterm survival after pancreatectomy …”

Improved Pancreaticoduodenectomy Outcomes after Starting a Specialized Community Hospital Pancreatic Surgery Program

“…In the face of centralization concerns, multiple community hospitals and surgeons at smaller institutions started publishing their results, showing comparable feasibility and safety in undergoing complex surgeries [11,13,32,33]. An ongoing debate exists now as to the nature of the defining denominators of superior outcomes in highvolume institutions [34].…”