Transitioning to a high volume centre for Whipple pancreaticoduodenectomy in Western Australia: a single centre experience

Abstract

Background: Pancreaticoduodenectomy (PD) is a curative resection for peri-ampullary tumours associated with high rates of peri-operative mortality and morbidity. The global trend is towards the establishment of high volume centres to reduce this. Australia faces geographical and population distribution challenges. Western Australia has centralized PD to two centres and we present the results of our institution in transitioning to a high volume centre. Methods: This was a prospective database of all PDs performed at our institution from 1 January 2005 to 2 April 2020. Mortality outcomes included peri-operative, 30 day and 90 day mortality. Complications, readmission and reinterventions at 90 days were recorded. The annual volume exceeded 20 from 2015. Outcomes prior to this were compared to characterize the transition to a high volume centre. Results: One hundred and twenty eight PDs were performed in

Pancreaticoduodenectomy in Australia: a national quality improvement clinical registry is long overdue

“…In comparison to international epidemiological studies, a Global Burden of Disease Study found that worldwide the agestandardized incidence of AP declined from 1990 to 2019, with an annual decrease of 8.4%. 6 That study reported an Australian age standardized incidence of 35-40/100 000 population, which is lower than the rate reported in this new analysis. From a regional perspective, the incidence of AP in New Zealand is reported as 58.42 per 100 000 population per year, with the incidence among Maori reaching 95.21 per 100 000 per year.…”

“…have extended their earlier review 2 by undertaking a meta‐analysis that confirms a lower in‐hospital mortality in high‐volume hospitals whatever the cut off 4,5 . In the other study, Yau et al 6 . report how a 16% statewide mortality prompted the Western Australia Health Department to centralize PD to three, now two, specialist units 7 .…”

Nationwide Outcomes of Pancreaticoduodenectomy for Pancreatic Malignancies: Center Volume Matters

“…The studies that do exist are often constrained by small sample sizes, single institution evaluations, or utilize databases outside the United States. [9][10][11][12][13] One major systematic review and meta-analysis comprising thirteen studies and more than 58,000 patients undergoing PD found a significant inverse association between overall mortality and increasing hospital volume status, with the greatest reduced odds of mortality occurring at hospitals with an annual volume of twenty to thirty or more PD per year. 10 Other studies have demonstrated differences in mortality after PD ranging from 2 to 4% with higher mortality observed at LVCs.…”

Quality of life after pancreatoduodenectomy: Is the outcome predetermined by the diagnosis?

“…2 Advancements in medicine and surgery, and centralization of pancreatectomy have led to the reduction in the adverse outcomes with a significant decrease in mortality to less than 2%. 3,4 With 5-year survival for resected pancreatic cancer rising up to 27%, a focus on quality of life (QoL) after PD has emerged during the past two decades. 5 QoL is of major importance in these patients for both patient selection and counseling on realistic postoperative expectations.…”

“…Known as the Whipple procedure, the operation leads to a significant alteration of the gastro‐intestinal tract, 1 and historically has been associated with significant morbidity, up to 26% in the recent literature, driven by surgical site infections and postoperative pancreatic fistulae (POPF) 2 . Advancements in medicine and surgery, and centralization of pancreatectomy have led to the reduction in the adverse outcomes with a significant decrease in mortality to less than 2% 3,4 …”