No mortality among 100 consecutive pancreaticoduodenectomies in a middle-volume center

Mortality rate following pancreaticoduodenectomy has markedly decreased in high-volume centers. We achieved zero mortality among 100 pancreaticoduodenectomies in a middle-volume center. The purpose of this study was to review our experience and analyze factors contributing to the zero mortality. Patient backgrounds, intraoperative variables, postoperative complications, and surgical, radiologic, and other medical interventions for the complications were retrospectively analyzed for 100 consecutive pancreaticoduodenectomies for malignant or benign disease. The mean age of the patients was 63 years. Altogether, 59 patients had preoperative co-morbidity, and 35 had a past history of abdominal surgery. The median operating time and blood loss were 525 minutes and 1215 ml, respectively. Postoperative complications occurred in 42 patients. The most frequent complication was pancreatic stump leak (n = 12), but no life-threatening pancreatic anastomotic leak occurred. This may result from the duct invagination anastomosis applied to 67 pancreases with a small duct. Serious complications were seen in six patients; two patients required surgical intervention, but four were successfully treated with the help of interventional radiologists or internists. Radiologic intervention was applied to 13 patients: drainage of an intraabdominal abscess/collection and vascular intervention. In addition to advances in surgical techniques to reduce local complications, particularly pancreatic anastomotic leak, intimate collaboration with experienced interventional radiologists and internists allows zero mortality even in middle-volume centers.