One thousand consecutive pancreaticoduodenectomies

Area of Science:

• Surgical Oncology
• Gastroenterology
• Hepatobiliary Surgery

Background:

• Pancreaticoduodenectomy, first performed in 1909 and popularized in 1935, historically had high mortality (~25%).
• Increased experience in high-volume centers since the 1980s significantly reduced mortality and improved outcomes.
• This evolution is traced through a single surgeon's experience with 1000 consecutive pancreaticoduodenectomies.

Purpose of the Study:

• To document the evolution of pancreaticoduodenectomy over five decades (1969-2003).
• To analyze the impact of accumulating surgical experience on patient management and outcomes.
• To assess the safety and efficacy of the procedure in a large, consecutive series.

Main Methods:

• Retrospective review of a prospectively maintained database.
• Analysis of 1000 consecutive pancreaticoduodenectomies performed by a single surgeon between March 1969 and May 2003.
• Evaluation of operative time, length of stay, mortality, and survival rates.

Main Results:

• Median operative time decreased from 8.8 hours (1970s) to 5.5 hours (2000s).
• Postoperative length of stay reduced from 17 days (1980s) to 9 days (2000s).
• Overall hospital mortality was 1% (10 deaths); 5-year survival for node-negative, margin-negative patients was 41%.

Conclusions:

• Pancreaticoduodenectomy is now a common and safe procedure in tertiary care centers.
• Significant reductions in operative time, blood loss, and length of stay have been achieved.
• The procedure is effective for pancreatic cancer, particularly in node-negative, margin-negative cases.