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Personal experience with the Whipple operation: outcomes and lessons learned
Verne L Hoshal1, Mary B Benedict, Lisa R David
1Department of General Surgery, St. Joseph Mercy Hospital, Ann Arbor, Michigan 48106, USA.
The American Surgeon
|March 12, 2004
Summary
This study shows pancreaticoduodenectomy (PD) is safe in community hospitals, with low mortality and few reoperations. Excellent long-term survival and functional status were achieved for periampullary malignancies.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Hepatobiliary Surgery
Background:
- Pancreaticoduodenectomy (PD) is a complex procedure.
- Its safety and outcomes in community hospitals require evaluation.
- High-volume centers report improved PD outcomes.
Purpose of the Study:
- To review outcomes of 134 consecutive pancreaticoduodenectomies (PDs).
- To evaluate the safety and efficacy of PD performed in a community hospital setting.
- To assess complication rates and long-term survival after PD.
Main Methods:
- Retrospective review of 134 PD cases performed between 1985 and 2002.
- All procedures were supervised by a single attending surgeon.
- Data collected included procedure type, patient demographics, complications, and survival.
Main Results:
- Overall mortality was 3.7%, with 28% experiencing major complications.
- Delayed gastric emptying (DGE) was the most frequent complication at 17.9%.
- 72% of patients had no complications, with an average hospital stay of 9.0 days.
Conclusions:
- Pancreaticoduodenectomy (PD) can be safely performed in community hospitals with general surgery residency programs.
- Low mortality and reoperation rates suggest PD is a feasible option outside major academic centers.
- Excellent long-term survival and functional status were observed in patients with periampullary malignancies.