Three Thousand Consecutive Pancreaticoduodenectomies in a Tertiary Cancer Center: A Retrospective Observational Study

Abstract

(1) Aim: To evaluate clinicopathological features and postoperative outcomes including survival in patients who underwent pancreaticoduodenectomy (PD) for periampullary diseases. (2) Methods: We retrospectively reviewed 3078 cases of PD performed in our center for 25 years. Periampullary diseases were divided into benign and malignancy groups. All cases were also classified by location. The time of 25 years was divided to different periods (5 years per period) to compare outcomes. Overall survival was compared between subdivided periods. (3) Results: Hospitalization became significantly shorter from 28.0 days in the 1st period to 13.8 days in the 5th period. Overall complication rate was significantly increased since the 3rd period. The rate without postoperative pancreatic fistula (POPF) was high at 98.7% in the 1st period. This might be because drain amylase on the 3rd day after PD was not routinely checked in the past. Thus, POPF was not detected. In survival analysis of adenocarcinoma of pancreas, bile duct, and ampulla, overall survival was found to be improved significantly in recent years. (4) Conclusions: Our study revealed that outcomes were improved with increasing number of PDs performed. Although POPF and overall complications showed increases more recently, those were detected and managed, resulting in shorter hospitalization and improved outcomes.

Surgical Outcome After Pancreatoduodenectomy for Duodenal Adenocarcinoma Compared with Other Periampullary Cancers: A Nationwide Audit Study

“…Patients with duodenal adenocarcinoma usually have both these risk factors, which poses them at greater risk for complications. 15,26 However, in the present analysis, even after adjustment for pancreatic texture and duct diameter, duodenal adenocarcinoma as an indication for pancreatoduodenectomy remained an independent risk factor for postoperative complications. In the current study, somatostatin analogs (octreotide or pasireotide) were used more often in patients with duodenal adenocarcinoma (67% vs. 60%; p = 0.03); however, the value of these agents in preventing POPF in all patients undergoing a pancreatoduodenectomy remains debated.…”

“…Patients with duodenal adenocarcinoma usually have both these risk factors, which poses them at greater risk for complications. 15 , 26 However, in the present analysis, even after adjustment for pancreatic texture and duct diameter, duodenal adenocarcinoma as an indication for pancreatoduodenectomy remained an independent risk factor for postoperative complications.…”

“…Only a few, mostly small, monocenter studies reported on surgical outcome after pancreatoduodenectomy for duodenal adenocarcinoma and compared these with outcomes for other periampullary tumors. 14,15,[22][23][24][25][26][27] An overview of these studies, based on a systematic search, is shown in Table 4. The reported rates of major complications after PD for duodenal adenocarcinoma varied between 18 and 24%.…”

“…The reported rates of major complications after PD for duodenal adenocarcinoma varied between 18 and 24%. 14 , 15 , 27 Some of these studies included only patients with duodenal adenocarcinoma, whereas others performed a subgroup analysis within a larger cohort. None of these studies included all endpoints reported in the current study.…”

“…[11][12][13] In surgical series on pancreatoduodenectomy, outcomes for patients with duodenal adenocarcinoma are often combined with other periampullary cancers because of their low incidence. [14][15][16] This results in limited knowledge of postoperative mortality and complication rates after pancreatoduodenectomy for duodenal adenocarcinoma. However, adequate identification of perioperative risk factors is pivotal for clinicians to better select patients with duodenal adenocarcinoma for curative resection and adequately counsel patients.…”