LOW MORTALITY RATE IN 97 CONSECUTIVE PANCREATICODUODENECTOMIES: the experience of a group

Abstract

-Context -Pancreaticoduodenectomy is the procedure of choice for resectable cancer of the periampullary region. These tumors account for 4% of deaths from cancer, being referred to as one of the lowest survival rates at 5 years. Surgery remains a complex procedure with substantial morbidity and mortality. Despite reports of up to 30% mortality rates, in centers of excellence it have been identified as less than 5%. Recent studies show that pancreaticojejunostomy represents the "Achilles' heel" of the procedure.Objective -To evaluate the post-operative 30 days morbidity and mortality rates. Methods -Retrospective analysis of 97 consecutive resected patients between July, 2000 and December, 2012. All patients were managed by the same group, and data were obtained from specific database service. The main objective was to evaluate the 30-day mortality rate, but we also studied data of surgical specimen, need for vascular resection and postoperative complications (gastric stasis, pancreatic fistula, pneumonia and reoperation rate).Results -Thirty-day mortality rate was 2.1% (two patients). Complete resection with no microscopic residual tumor was obtained in 93.8% of patients, and in 67.3% of cases pathology did not detected metastatic nodes. Among postoperative complications were reported 6% of prolonged gastric stasis, 10.3% of pneumonia, 10.3% of pancreatic fistula and 1% of infection in the drain pathway. Two patients underwent reoperation due to bleeding and infected hematoma caused by pancreatic fistula, and another for intestinal obstruction because of adhesions at postoperative day 12. Conclusion -The pancreaticoduodenectomy as treatment procedure for periampullary cancers has a low morbidity and mortality rate in services with experience in Hepato-Pancreato-Biliary surgery, remaining as first-line treatment in resectable patients. HEADINGS -Pancreatic neoplasms. Pancreaticoduodenectomy. Mortality.

Fifty consecutive pancreatectomies without mortality

“…Although one can notice a progressive increase in the complexity of procedures over time, most cases were operated on due to benign disease and subjected to resection of body and tail of pancreas, reflecting a Table 2 -Table 2 -Table 2 -Table 2 -Table 2 Table 3 -Table 3 -Table 3 -Table 3 - Table 3 . In this study, the average hospital stay was 15 days, the fistula rate of pancreatic clinic, 10.3%, and the mortality rate, 2.1% 16 .…”

Early Drain Fluid Amylase Is Useful to Predict Pancreatic Fistula After Pancreatoduodenectomy: Lessons Learned From a Southern Brazilian Center

“…Despite different descriptions regarding the anastomosis of the pancreatic remnant after PD, surgeons still do not have a proven superior technique (1) . Even in some high-volume centers, the pancreatic fistula rate is about 30% (3) .…”

“…Pancreatoduodenectomy (PD) still represents a challenging operation. Despite a significant decrease in the mortality rate after pancreatic head surgery, observed in centers of excellence in the last few years, morbidity rate did not follow this reduction, being in a steady state of about 40%-60% (1) . The most feared complication that supplies these statistics is pancreatic fistula (PF) (2) .…”

Shen’s Whole-Layer Tightly Appressed Anastomosis Technique for Duct-to-Mucosa Pancreaticojejunostomy in Pancreaticoduodenectomy

“…The postoperative complication rate remains high, varying from 20% to 60% [ 12 ]. With the marked improvement in postoperative outcomes of PD in recent years, postoperative morbidity has considerably decreased [ 13 ]. Some large centers can even control their postoperative morbidities by approximately 5%.…”