Twelve Hundred Consecutive Pancreato‐Duodenectomies from Single Centre: Impact of Centre of Excellence on Pancreatic Cancer Surgery Across India

Abstract

Background Pancreato-duodenectomy (PD) is a technically challenging operation with significant morbidity and mortality. Over the period of time, Tata Memorial Centre has evolved into a high-volume centre for management of pancreatic cancer. Aim of this study is to report the short-and long-term outcomes of 1200 consecutive PDs performed at single tertiary cancer centre in India. Methods 1200 PDs were performed from 1992 to 2017. Prospectively maintained database was used to retrospectively assess the short-and long-term outcomes.Results Study cohort was divided into periods A and B (500 and 700 patients, respectively). Both groups were comparable for demographic variables. Overall morbidity and mortality in entire cohort were 31.2% and 3.9%, respectively. Period B documented significant reduction in post-operative mortality (5.4% vs 2.8%), post-pancreatectomy haemorrhage (5.8% vs 3%) and bile leaks (3.4% vs 1.3%). However, incidence of delayed gastric emptying and clinically relevant post-operative pancreatic fistula was higher in period B. With median follow-up of 25 months, 3-year overall survival and disease-free survival for patients with pancreatic cancer were 43.7% and 38.7%, respectively, and that for periampullary tumours were 65.9% and 59.4%, respectively. Period B also corresponded with dissemination of technical expertise across diverse regions of India with specialised training of 35 surgeons. Conclusion Our study demonstrates the feasibility of delivering high-quality care in a dedicated high-volume centre even in a country with low incidence of pancreatic cancer with marked disparities in medical care and socioeconomic conditions. Improved outcomes underscore the need to promote regionalisation via a dedicated training programme. Shailesh V. Shrikhande and Rajesh S. Shinde have contributed equally to this manuscript.

Does Preoperative Serum Neutrophil to Lymphocyte Ratio (NLR), Platelet to Lymphocyte Ratio (PLR), and Lymphocyte to Monocyte Ratio (LMR) Predict Prognosis Following Radical Surgery for Pancreatic Adenocarcinomas? Results of a Retrospective Study

“…With considerable improvement in survival over past decades and corresponding decrease in morbidity [30] ,identi cation of prognostic markes should help us in further improving patient outcomes .However our study did not nd any signi cant association between this markers and overall survival and although the survival was better with low NLR and high LMR for all cut offs, it did not reach statistical signi cance. One of the reasons for this may be that, although individually this test may not be predictive of survival, a combination of two or more of these variables may be a better marker to assess prognosis.…”

Outcomes of Elective Major Cancer Surgery During COVID 19 at Tata Memorial Centre

“…Our low rates of major complications and zero mortality in this series 494 resections over 5 weeks not only reflects our '''Covid 19 centric policy'' of case selection, adopting best surgical practices and having the best operating teams (average age 40 years) led by senior consultants (with an average age of 48 years) but also confirm that there were no deviations from earlier benchmarks established by the various surgical specialties in the pre-Covid era. [7][8][9][10] Also, all 6 patients detected with COVID infection in the postoperative period, did not develop any major complication with uneventful recovery. Although a small number, all of them had undergone major resections.…”

Surgical Feasibility, Determinants, and Overall Efficacy of Neoadjuvant 177Lu-DOTATATE PRRT for Locally Advanced Unresectable Gastroenteropancreatic Neuroendocrine Tumors

“…Hence, in our study, we use objective resectability criteria (given by NCCN for PDAC) for determining resectability of primary tumor (as shown in fig2 and fig 4). GEP-NETs patients described in our study were all deemed unresectable primary before PRRT by a surgeon with expertise in GI and Hepato-Pancreato-Biliary (HPB) surgery 22 . PRRT is generally well tolerated as compared to chemotherapy and other treatment modalities in GEP-NETs.…”