Surgical and oncological outcomes of pancreaticoduodenectomy- Single institutional retrospective analysis

Dr.C.Srinivas; Dr. Pavan Kumar J; Dr. Karthik; Dr. C. Ramachandra

Volume : VIII, Issue : IX, September - 2019

Surgical and oncological outcomes of pancreaticoduodenectomy- Single institutional retrospective analysis

Dr. C. Srinivas, Dr. Pavan Kumar J, Dr. Karthik, Dr. C. Ramachandra

Abstract :

Background: Whipple�s pancreaticoduodenectomy (PD) described in 1945 had mortality of 38%. With advances in surgical management of PD, mortality rate for PD has been reported to be less than 5%. Postoperative pancreatic fistula (POPF) remains a major complication and morbidity after PD with incidence upto 40%. Materials and Methods: This is a retrospective analyses of patients who underwent PD from a tertiary cancer center in southern India from Jan 2013 to Dec 2017. Preoperative, intraoperative, postoperative details and surgico–oncological outcomes are presented. Results: Of 76 patients presumed as operable periampullary cancers, 16 were declared inoperable and data analyzed for remaining 60 patients. 44% underwent classical Whipple�s PD and 56% pylorus preserving PD. Duct to mucosa pancreaticojejunostomy was performed in all patients. Mean operative time, blood loss and hospital stay was 293�68.6min,695�300ml and 13�6days; 8% developed grade A delayed gastric emptying(DGE); POPF Grade B in 5%. Wound infection(25%) and pneumonia(15%) are common postop complications; Five patients (8%) had biliary fistula; 30 day in–hospital–mortality was 1.6%; 60% had periampullary tumours; Median survival was 22 months (Range7–76 months); 10% developed liver metastasis on follow up. Conclusions: Pancreaticoduodenectomy is a safe operation in experienced hands. Surgical results from our center is comparable to the literature published from centers of excellence.