Pancreaticoduodenectomy: A study from India on the impact of evolution from a low to a high volume unit

Shah, Omar Javed; Singh, Manmohan; Lattoo, Mohammad R; Bangri, Sadaf Ali

doi:10.4240/wjgs.v8.i8.583

Cited by 8 publications

(13 citation statements)

References 23 publications

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“…The reported postoperative fistula rates at three other centers from India were 15%, 15.39%, and 12% respectively, 24–26 and the fistula rate at our center was 17.0%. Studies have shown that high volume centers and high volume surgeons provide best outcomes after pancreaticoduodenectomy 25,27,28 .…”

Section: Discussionmentioning

confidence: 44%

Postoperative pancreatic fistulas after pancreaticoduodenectomy for malignancy: A Northeast Indian tertiary cancer center study

et al. 2021

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Background and Aim Postoperative pancreatic fistula (POPF) is an important cause of major morbidity and mortality after pancreaticoduodenectomy. We intend to estimate the incidence and study the risk factors and outcomes of patients who developed this dreaded complication. Methods This is a retrospective observational study. We included all patients who underwent pancreaticoduodenectomy at a specialized surgical unit of a single tertiary care cancer center in Northeast India. The period of study was from 23 April 2012 to 27 December 2019. The 2016 update on the definition of POPF by the International Study Group for Pancreatic Fistula was used to define the complication. Chi‐square test and Fischer's exact test were applied to categorical variables. t‐test was used to quantify mean difference among continuous variables. P value <0.05 was considered statistically significant at 95% confidence interval. Results A total of 59 patients underwent pancreaticoduodenectomy during the study period with almost equal distribution among males and females (29 and 30 patients respectively). The mean age of the patients was 54.0 years (range 20–72). Grade A, B, and C pancreatic fistulas were seen in five (8.5%), three (5.1%), and two (3.4%) patients, respectively. Preoperative hyperbilirubinemia, pancreatic duct size ≤3 mm, hypoalbuminemia, preoperative biliary decompression, and prolonged duration of surgery were identified as risk factors for POPF. POPF also resulted in increased 90‐day mortality (20%). Conclusion POPF remains a potentially life‐threatening complication of pancreaticoduodenectomies. The knowledge and management of modifiable risk factors for this condition may help in mitigating this problem.

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Section: Discussionmentioning

confidence: 44%

Postoperative pancreatic fistulas after pancreaticoduodenectomy for malignancy: A Northeast Indian tertiary cancer center study

et al. 2021

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“…There is a growing but stable trend in achieving acceptable and comparable outcomes in community hospitals adopting pancreatic surgery. This is largely due to high-volume experienced surgeons migrating to community hospitals, and thus altering these institutions' status into high-volume hospitals [11,13,32,37].…”

Section: Discussionmentioning

confidence: 99%

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

Younan¹,

Andrews²,

Rangarajan³

et al. 2020

Med Clin Res Open Access

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Background: Recent trends in centralization of pancreatic surgery happened as a response to improved outcomes in tertiary care institutions. The volume-outcome relationship is true for high volume hospitals and surgeons. Obstacles to patient travelling to high volume institutions and widespread quality care in community hospitals led to establishing a quality specialized pancreatic surgery program in the community. Methods: Two pancreatic surgery specialists relocated their program from a tertiary care center to a community hospital. Results of the first sixty-two pancreaticoduodenectomy and total pancreatectomy procedures were studied. Results: One hundred and seventeen pancreatic surgery cases were analyzed, sixty-two pancreaticoduodenectomy and total pancreatectomy cases were included. Patient demographics were not different in regard to the median age (67 vs. 62 years), gender (65 vs. 62% males), median BMI (26.2 vs. 26 kg/m2), or American Society of Anesthesiologists class, in between the two hospitals. There was a significant decrease in the operative time (350 vs. 281 minutes, p=0.0001), estimated blood loss (409 vs. 156 milliliters, p=0.003), and length of hospital stay (7.2 vs. 5.2 days, p=0.0001). Most patients were operated on for a diagnosis of malignancy (74.2%), and the R0 resection rate was better at the community hospital reaching 95.2%. Transfusions, delayed gastric emptying and leaks tended to be better at the community hospital but did not reach statistical significance. Conclusion: With dedicated institutional support and careful program design, complex procedures such as PD can be successfully relocated to the community where superior results can be achieved.

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“…Pancreatic cancer remains one of the cancers with the poorest prognosis, with an overall 5-year survival rate of about 5%, without much difference between high-income countries and low-income and middleincome countries [1]. Pancreaticoduodenectomy (PD) is a complex, high-risk surgical procedure usually performed for malignancy of the pancreatic head or periampullary region [2].…”

Section: Introductionmentioning

confidence: 99%

“…Major postoperative complications include: pancreatic leak or stula, intra-abdominal abscess, bile leak, postoperative hemorrhage requiring blood transfusion or re-exploration, delayed gastric emptying, and complications related to the surgical site such as infection and wound dehiscence [6]. Various studies have demonstrated that high volume tertiary centers have signi cantly lower (< 5%) in-hospital mortality rates for pancreaticoduodenectomy than the low volume centers (> 10%) [2]. We set out to conduct this systematic research to link our evidence regarding the volume of cases and outcome at tertiary care center in underdeveloped country and to implement the data to improvise our practice in managing such patients, and analyze the impact of turning our department from a medium to a high volume care provider of PD.…”

Section: Introductionmentioning

confidence: 99%

Pancreaticoduodenectomy: Impact of Volume on Outcomes at a Tertiary Care Center—Our Experience in Single Institute of Nepal

Agrawal

Das

Sah

et al. 2021

J Gastrointest Canc

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BackgroundPancreaticoduodenectomy is a complex high risk surgical procedure usually done for malignant disease carrying signi cant postoperative morbidity and mortality. An audit and analysis of rate of postoperative morbidity and mortality and the impact of case volume can provide information about the lacunas in patient care and methods to improve it for safe and early discharge of patients. This study was conducted to nd out demographic pro le, the rate of perioperative morbidities, mortality and impact of case volume on patients undergoing pancreaticoduodenectomy for malignant disease which may serve as a guide to uplift the patient care in our center. MethodsRetrospective analysis of prospectively collected data of patients undergoing pancreaticoduodenectomy from 2015 to 2019 was performed. A total of 62 patients were included in the study. Patients clinicdemographic details, intraoperative and postoperative events were recorded. Rate of various postoperative morbidities and mortality and year wise trend of these factors were analyzed. ResultsMost of the patients were in sixth decade of life (38.7%) with male preponderance (61.3%). Pancreatic cancer was most commonly seen followed by cholangiocarcinoma (46.8%). SSI (32.3%), intraabdominal collection (25.8%), anastomotic leak (14.5%), pancreatic stula (22.6%), postpancreatectomy hemorrhage (8.1% ) were the major postoperative events. Mortality was found in 12.9% patients. ConclusionThere has been a decrease in rate of all these postoperative adverse events and improvement in the intraoperative blood loss and surgical duration with advancing years and increasing number of cases.

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Pancreaticoduodenectomy: A study from India on the impact of evolution from a low to a high volume unit

Abstract: The transformation from a low volume to a high volume provider of PD resulted in most favourable outcomes favouring the continued centralization of this high risk procedure.

Cited by 8 publications

References 23 publications

Postoperative pancreatic fistulas after pancreaticoduodenectomy for malignancy: A Northeast Indian tertiary cancer center study

Postoperative pancreatic fistulas after pancreaticoduodenectomy for malignancy: A Northeast Indian tertiary cancer center study

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

Pancreaticoduodenectomy: Impact of Volume on Outcomes at a Tertiary Care Center—Our Experience in Single Institute of Nepal

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