Lessons learned from 300 consecutive pancreaticoduodenectomies over a 25-year experience: the “safety net” improves the outcomes beyond surgeon skills View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2017-12

AUTHORS

Roberto Santoro, Roberto Luca Meniconi, Pasquale Lepiane, Giovanni Vennarecci, Gianluca Mascianà, Marco Colasanti, Eugenio Santoro, Giuseppe Maria Ettorre

ABSTRACT

Pancreaticoduodenectomy (PD) is associated with high postoperative morbidity. The management of postoperative complications is paramount for reducing the mortality rate. The aim of this study was to evaluate the importance of surgical and hospital experience on outcomes by comparing postoperative results in three different hospitals with increasing resources for supporting the same surgical team. Patients data and surgical outcome of 300 consecutive patients undergoing PD were collected prospectively in the department database and divided into three periods (A = 1990-2000, B = 2001-March 2007, C = April 2007-2015). Pancreatico-jejunostomy was the procedure of choice between 1995 and 2004, and pancreatico-gastrostomy was performed afterwards. In the periods A, B and C, a total of 78, 85 and 137 PD were performed, respectively, and the number of PDs per year increased from 5 to 25. Between the three periods, the death rate (10.4 vs. 6 vs. 1.6%, p = 0.01) and intraoperative RBC transfusion rate (84.9 vs. 42.4 vs. 6.5%, p = 0.01) decreased significantly, whereas the vascular resection rate increased significantly (1.2 vs. 7 vs. 14.5, p < 0.002). Morbidity and reoperation rates did not change significantly between the three periods as well as operative time and median length of stay. Infectious complications and sepsis represented the most frequent major complication. Massive bleeding associated with uncontrolled pancreatic leak represented the major cause of morbidity and reoperation in the three periods, however, the relative mortality rate decreased significantly with no deaths in the last period. PD remains a challenging procedure with high morbidity and mortality rate. A multidisciplinary pancreatic team represents the "safety net" of pancreatic surgeon because it improves the results beyond the surgeon skills and experience. More... »

PAGES

451-460

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s13304-017-0490-4

DOI

http://dx.doi.org/10.1007/s13304-017-0490-4

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1091421508

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/28864848


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