Short- and long-term outcomes in 1438 consecutive pancreatoduodenectomies: a single-center 25-years' experience

Abstract

Background: This study evaluated the changes over time in patient selection, surgical and oncological outcomes for pancreatoduodenectomy (PD) during a 25-year period in a high-volume pancreatic center. Methods: All consecutive PDs from 1992–2017 in our institution were identified from a prospectively maintained database. Baseline characteristics, complications (ISGPS grade B/C), mortality and survival were analyzed according to three periods (P1, 1992–2000; P2, 2001–2009; P3, 2010–2017). Results: In total, 1438 patients underwent PD, of which 25.4% in P1, 33.9% in P2 and 40.7% in P3. Over time, the annual PD-volume increased, patients were older, and underwent more often minimally-invasive PD (all p< 0.001). The postoperative pancreatic fistula-rate was 16.0%, postpancreatectomy hemorrhage-rate 8.0% and delayed gastric emptying-rate 31.0%, all without improvement over time, whereas median length of stay decreased from 16 to 12 days (p=0.007). The in-hospital mortality rate was 2.2% (p=0.46 over time). In 531 patients (36.9%) with PDAC, the proportion of pT3/T4 cancers increased over time (60.3% to 80.4%), the use of both adjuvant and neoadjuvant chemotherapy increased, and the five-year survival rate improved from 9.9% to 18.9% (all p< 0.001). On multivariate analysis, use of adjuvant chemotherapy but not period of surgery was an independent predictor of survival. Conclusions: During a 25-year period in a high-volume center, the complication and in-hospital mortality rates after PD remained low and stable, whereas length of hospital stay decreased despite operating on older patients. Five-year overall survival for PDAC doubled, despite operating on more advanced cancers, mainly due to increased use of adjuvant chemotherapy.