Ann Surg Treat Res.  2019 Sep;97(3):130-135. 10.4174/astr.2019.97.3.130.

One hundred sixty pancreaticoduodenectomies for periampullary cancers in a growing-volume setting: a single-institution and a single-surgeon's experience

• Chang SH

• KMID: 2455973
• DOI: http://doi.org/10.4174/astr.2019.97.3.130

Abstract

PURPOSE
Many studies have concluded that cancer patients may have better outcomes when their surgery is performed in high-volume centers, especially when the procedure is pancreaticoduodenectomy (PD). However, some studies concluded that experienced surgeons or incorporation of expertise from high-volume centers may achieve satisfactory outcomes after PD in low-volume centers.
METHODS
I retrospectively collected and analyzed the outcomes of PD for periampullary cancers treated with curative intent in my center.
RESULTS
From August 2, 2005 to December 10, 2018, 160 pancreatic resections were done with curative intent in my center. The number of operations per year was 1 in 2005 and gradually increased to 21 in 2018. Thirty-day mortality was 0, and 90-day mortality was 1 (0.6%). Morbidity was found in 65 cases (40.6%). The median follow-up period was 23.2 months and 5-year survival rates were 28.5% for pancreas head cancer, 48.2% for distal CBD cancer, and 72.6% for AOV cancer. I divided patients into 2 groups by the number of annual operations, which is more than 21 per 2 years. The 2 groups showed no differences in terms of morbidity and mortality.
CONCLUSION
A well-trained low-volume surgeon may perform PD safely at a well-equipped low-volume center.

Keyword

Outcome; Pancreaticoduodenectomy; Periampullary cancer; Volume

MeSH Terms

Follow-Up Studies
Head and Neck Neoplasms
Humans
Mortality
Pancreas
Pancreaticoduodenectomy*
Retrospective Studies
Surgeons
Survival Rate

Figure

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  Fig. 1 The number of procedures per year for periampullary cancers.

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  Fig. 2 Survival rates of 160 periampullary cancers according to histologic types. AOV, ampulla of Vater; CBD, common bile duct.

Reference

1. Begg CB, Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA. 1998; 280:1747–1751.

2. Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003; 349:2117–2127.

3. Finlayson EV, Birkmeyer JD. Effects of hospital volume on life expectancy after selected cancer operations in older adults: a decision analysis. J Am Coll Surg. 2003; 196:410–417.

4. Fong Y, Gonen M, Rubin D, Radzyner M, Brennan MF. Long-term survival is superior after resection for cancer in high-volume centers. Ann Surg. 2005; 242:540–544.

5. Birkmeyer JD, Sun Y, Goldfaden A, Birkmeyer NJ, Stukel TA. Volume and process of care in high-risk cancer surgery. Cancer. 2006; 106:2476–2481.

6. van der Geest LG, van Rijssen LB, Molenaar IQ, de Hingh IH, Groot Koerkamp B, Busch OR, et al. Volume-outcome relationships in pancreatoduodenectomy for cancer. HPB (Oxford). 2016; 18:317–324.

7. Schmidt CM, Turrini O, Parikh P, House MG, Zyromski NJ, Nakeeb A, et al. Effect of hospital volume, surgeon experience, and surgeon volume on patient outcomes after pancreaticoduodenectomy: a single-institution experience. Arch Surg. 2010; 145:634–640.

8. Kanhere HA, Trochsler MI, Kanhere MH, Lord AN, Maddern GJ. Pancreaticoduodenectomy: outcomes in a low-volume, specialised Hepato Pancreato Biliary unit. World J Surg. 2014; 38:1484–1490.

9. Chedid AD, Chedid MF, Winkelmann LV, Grezzana Filho TJ, Kruel CD. Achieving good perioperative outcomes after pancreaticoduodenectomy in a low-volume setting: a 25-year experience. Int Surg. 2015; 100:705–711.

10. Sosa JA, Bowman HM, Gordon TA, Bass EB, Yeo CJ, Lillemoe KD, et al. Importance of hospital volume in the overall management of pancreatic cancer. Ann Surg. 1998; 228:429–438.

11. Gouma DJ, van Geenen RC, van Gulik TM, de Haan RJ, de Wit LT, Busch OR, et al. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg. 2000; 232:786–795.

12. Kotwall CA, Maxwell JG, Brinker CC, Koch GG, Covington DL. National estimates of mortality rates for radical pancreaticoduodenectomy in 25,000 patients. Ann Surg Oncol. 2002; 9:847–854.

13. Rosemurgy A, Cowgill S, Coe B, Thomas A, Al-Saadi S, Goldin S, et al. Frequency with which surgeons undertake pancreaticoduodenectomy continues to determine length of stay, hospital charges, and inhospital mortality. J Gastrointest Surg. 2008; 12:442–449.

14. Ho V, Heslin MJ. Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy. Ann Surg. 2003; 237:509–514.

15. Topal B, Van de Sande S, Fieuws S, Penninckx F. Effect of centralization of pancreaticoduodenectomy on nationwide hospital mortality and length of stay. Br J Surg. 2007; 94:1377–1381.

16. Balcom JH 4th, Rattner DW, Warshaw AL, Chang Y, Fernandez-del Castillo C. Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg. 2001; 136:391–398.

17. Traverso LW, Shinchi H, Low DE. Useful benchmarks to evaluate outcomes after esophagectomy and pancreaticoduodenectomy. Am J Surg. 2004; 187:604–608.

18. Schmidt CM, Powell ES, Yiannoutsos CT, Howard TJ, Wiebke EA, Wiesenauer CA, et al. Pancreaticoduodenectomy: a 20-year experience in 516 patients. Arch Surg. 2004; 139:718–725.

19. Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg. 2006; 10:1199–1210.

20. Cameron JL, Riall TS, Coleman J, Belcher KA. One thousand consecutive pancreaticoduodenectomies. Ann Surg. 2006; 244:10–15.

21. Chew DK, Attiyeh FF. Experience with the Whipple procedure (pancreaticoduodenectomy) in a university-affiliated community hospital. Am J Surg. 1997; 174:312–315.

22. Kim H, Chung JK, Ahn YJ, Lee HW, Jung IM. The 13-year experience of performing pancreaticoduodenectomy in a mid-volume municipal hospital. Ann Surg Treat Res. 2017; 92:73–81.

23. Cooperman AM. Pancreatic cancer: the bigger picture. Surg Clin North Am. 2001; 81:557–574.

24. Afsari A, Zhandoug Z, Young S, Ferguson L, Silapaswan S, Mittal V. Outcome analysis of pancreaticoduodenectomy at a community hospital. Am Surg. 2002; 68:281–284.

25. Sarr MG. Lessons learned from HPB surgery in Kathmandu, Nepal. World J Surg. 2010; 34:1922–1923.