Ten-Year Experience With 733 Pancreatic Resections

Abstract

Hypothesis: Experience with pancreatic resection for the last 10 years has resulted in new trends in patient characteristics and, for pancreaticoduodenectomy (PD), a decrease in the length of stay (LOS). This decrease is due in part to the implementation of case management and clinical pathways. Design: Retrospective case series of patients undergoing pancreatic resection. Setting: A university-affiliated, tertiary care referral center. Patients: The study comprised 733 consecutive patients undergoing pancreatic resection for benign or malignant disease at the Massachusetts General Hospital in Boston from April 1990 to March 2000. Interventions: Of the 733 pancreatic resections, 489 were PD; 190, distal pancreatectomy; 40, total pancreatectomy; and 14, middle-segment pancreatectomy. Main Outcome Measures: Length of stay; occurrence of delayed gastric emptying, pancreatic fistula, reoperation, readmission, or other complications; mortality; and comparison of patients in 3 periods according to the implementation of case management (July 1995) and clinical pathways (September 1998).

Outcome of Distal Pancreatectomy for Pancreatic Adenocarcinoma

“…Hence, until recently, few large series reporting the results of surgical resection and outcome of adenocarcinoma of the body and tail of the pancreas have been published [3, 4,14,15,16,17,18,19] (table 4). However during the past few years, with improved morbidity and mortality rates of pancreatic resection [7, 8], many high-volume tertiary institutions are reporting increasing numbers of patients with excellent short-term results if not long-term survival after distal pancreatectomy for adenocarcinoma of the body and tail of the pancreas [3, 4, 14, 15]. …”

“…This was further compounded by the high rates of morbidity and mortality of pancreatic resection [6]. In recent times, with improvements in technique and postoperative care, the morbidity and mortality of pancreatic surgery has fallen to acceptable rates [7, 8], allowing even radical extended resections [3, 4, 9]. This study aims to determine the outcome of patients undergoing distal pancreatectomy for pancreatic adenocarcinoma in the body and tail of the pancreas.…”

Factors Associated with Survival after Surgical Resection in Chinese Patients with Ductal Adenocarcinoma of the Pancreatic Head

“…In most institutions, the reported surgical mortality rate ranges from 1 to 15% [10,11,12,13]; in many centers of excellence, major pancreatic resections are undertaken with a 1–2% mortality rate [11, 12]. The fear of uncontrolled hemorrhage and postoperative pancreatic fistula were major impediments to the evolution of pancreatic resection as an effective form of therapy.…”

“…The fear of uncontrolled hemorrhage and postoperative pancreatic fistula were major impediments to the evolution of pancreatic resection as an effective form of therapy. While bleeding remains a concern, surgical techniques have improved greatly, and experienced centers have achieved significant reduction in blood loss and transfusion requirements as well as incidence of pancreatic fistula, even after EPD resections [5, 12, 27]. Most surgeons rely on personal preferences or patient-specific circumstances (e.g., inflammation or tumor extension into the distal stomach) to determine which type of resection to pursue.…”

Surgical treatment of the pancreatic stump: preventive strategies of pancreatic fistula after pancreatoduodenectomy for cancer

“…At present pancreatic leak is the most significant complication from which 40% of Patients death are the result of septic or of hemorrhagic complications. Rates up to 20% are reported from Centers specialized in pancreatic surgery without reduction in the past decade (3,4). However, the definition of pancreatic fistula is not standardized and universally accepted.…”