Good results after major pancreatic resections in a middle-volume center.

OBJECTIVES

Recently, hospital and surgeon volume is widely discussed as a prognostic factor after major pancreatic surgery. We present our experience regarding major pancreatectomy in a middle-volume center.

METHODS

During the last 11 years, 66 patients underwent major pancreatectomy (pancreaticoduodenectomy [n = 52], distal pancreatectomy with splenectomy [n = 13], and central pancreatectomy [n = 1]). Postoperative course and long-term outcome were recorded and analyzed.

RESULTS

One patient died after pancreaticoduodenectomy for ampullary cancer (total mortality of approximately 1.5% for the whole group of patients or 1.9% for the group of patients who underwent pancreatoduodenectomy). None of our patients was reoperated on. Transient pancreatic fistula was observed in 46 patients (36 patients after pancreatoduodenectomy [69%] and 10 patients after distal pancreatectomy [77%]). Two patients required percutaneous computed tomography-guided drainage of fluid collections, whereas in another one, a tube thoracostomy was performed to drain a pleuritic fluid collection. Delayed gastric emptying was observed in 6 patients after pancreatoduodenectomy. Median survival for the whole group of patients was 17 months.

CONCLUSIONS

Major pancreatic resections can be performed safely, with acceptable morbidity and mortality and good long-term results, even in middle-volume centers. However, experience is required from the part of the operating surgeon.

ABBREVIATIONS: PD - pancreatoduodenectomy, DP - distal pancreatectomy, PPPD - pylorus-preserving pancreatoduodenectomy.