Early outcome of whipple surgery in single center in sub-Saharan Africa

Abstract

Background: No data was available about the magnitude of pancreatic cancer in Sudan and most of the patients who afford used to travel abroad seeking medical l management , our team was the first to establish a dedicated HPB surgery unit in Sudan Methods: our medical records was retrospectively reviewed and analyzed using data sheet and SPSS Results: one hundred eighty four patients were operated in the period from January 2016- January 2018. 43.8% were males , 56.2% were females .Mean age was 56+/- 11.1 (34-75) , mean duration of symptoms 4.5+/-2.6 months ,93.7% had Total bilirubin > 15 mg/dl , preoperative biliary drainage was done in 85% of the patients . locally advanced PDAC was detected in 16% of the patients by CT Scan preoperatively . Classical Whipple surgery was performed in 80% , and PPPD in 20% . Neoadjuvant radiochemotherapy was used in four patients with SMA involvement . Tumor diameter 4.5+/-1.5 cm . it was T3 in 72% of the cases and N1 in 67% . Specimen pathology showed PDAC in 58% , CCa in 16.6% , Deoudenal Adenocarcinoma in 9.3% , Ampullary tumor in 4.2% , NET in 6.2% and 2.1% other pathologies. Pancreatic Anastomosis was duct to mucosa in 91% and Dunking in 9% . Postoperative pancreatic fistula Grade A developed in five patients & two patients had Grade B . Conclusion: we succeeded in establishing new service in our low income country with Results similar to international Results with acceptable complication rate and excellent outcome despite the late presentation of our patients , we implement neoadjuvant therapy in some of our locally advanced cases and even in some resectable cases because of our long waiting list , the long term Results of which is going to be studied further .