Abstract
BackgroundHospital volume, surgeons’ experience, and adequate management of complications are factors that contribute to a better outcome after pancreatic resections. The aim of our study was to analyze trends in indications, surgical techniques, and postoperative outcome in more than 1,100 pancreatic resections.MethodsOne thousand one hundred twenty pancreatic resections were performed since 1994. The vast majority of operations were performed by three surgeons. Perioperative data were documented in a pancreatic database. For the purpose of our analysis, the study period was sub-classified into three periods (A 1994 to 2001/n = 363; B 2001 to 2006/n = 305; C since 2007 to 2012/n = 452).ResultsThe median patient age increased from 51 (A) to 65 years (C; P < 0.001). Indications for surgery were pancreatic/periampullary cancer (49%), chronic pancreatitis (CP; 33%), and various other lesions (18%). About two thirds of the operations were pylorus-preserving pancreaticoduodenectomies. The frequency of mesenterico-portal vein resections increased from 8% (A) to 20% (C; P < 0.01). The overall mortality was 2.4% and comparable in all three periods (2.8%, 2.0%, 2.4%; P = 0.8). Overall complication rates increased from 42% (A) to 56% (C; P < 0.01).ConclusionsMortality remained low despite a more aggressive surgical approach to pancreatic disease. An increased overall morbidity may be explained by more clinically relevant pancreatic fistulas and better documentation.
Highlights
Hospital volume, surgeons’ experience, and adequate management of complications are factors that contribute to a better outcome after pancreatic resections
Distribution of gender shows a shift from male to female which is due to the higher prevalence of patients with chronic pancreatitis during period A
This explains the observed shift from benign to malignant diagnoses. This may be explained by epidemiological differences in disease prevalence of chronic pancreatitis between North and South Germany
Summary
Surgeons’ experience, and adequate management of complications are factors that contribute to a better outcome after pancreatic resections. The aim of our study was to analyze trends in indications, surgical techniques, and postoperative outcome in more than 1,100 pancreatic resections. One major advance in pancreatic surgery over the past two decades is the resection of premalignant pancreatic lesions to prevent development of pancreatic cancer [1]. This is only possible because pancreatic resections have developed into routine procedures with low mortality [2]. Many factors like hospital volume, surgeons’ experience, and improved management of postoperative complications are known to improve the outcome of pancreatic surgery [3]. We examine the morbidity and mortality during 18 years of surgical practice in a collective of 1,120 patients who underwent resections of the pancreas in a single institution cohort
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