Results of Five Years of a Specialized Unit in Pancreatic Surgery

Abstract

Purpose: Pancreatic surgery is technically demanding, and requires multidisciplinary management to achieve good results. These are clearly influenced by the volume of cases performed. A specific unit of pancreatic surgery was created in our 900-bed center in 2016 in order to centralize the cases and improve the results. Methods: We present the Results of the first five years of our unit. Results: 172 surgeries (3 case/month) including 72 Whipple procedures (WP), 63 left pancreatectomies (LP). Among them 68 adenocarcinomas, 26 neuroendocrine tumors and 25 cystic neoplasms. Median age: 66 years. Mortality: 4.1%. Significant morbidity (Clavien-Dindo ≥III): 22.1%. Median hospital stay: 12 days (17 days after WP, 8 days after LP). Of the WP, 75% were adenocarcinomas. Pancreatic fistula: 44.4%, B/C grade: 11.1%. Significant morbidity: 27,8%. Of the LP, 13 were adenocarcinomas, 22 neuroendocrine tumors, 3 metastasis, 15 cystic neoplasms. B/C grade fistula: 3.2%. Significant morbidity: 14.3%. 15 cases were performed laparoscopically with good results (median stay 7 days, significant morbidity 0%, fistula 10 of 15, all grade A). Of the 68 resectable adenocarcinomas, 77.9% required WP and 19.1% needed LP. Neoadjuvant treatment: 13.23%. Venous resection: 11.8%. Mortality: 7.4%, significant morbidity 27.9%. R0 resection: 51.5%, R1 was due to unavoidable involvement of anterior and posterior margins in 33 cases. 1-year survival: 82.7%. 1-year disease-free survival: 50%. Conclusion: Pancreatic surgery is demanding and is generally taxed with high morbidity, which may justify the creation of specific surgical teams. We believe that our results are acceptable although there is still room for improvement.