Pancreaticoduodenectomy: a developing country perspective

Area of Science:

• Gastroenterology and Hepatology
• Surgical Oncology
• Abdominal Surgery

Background:

• The Whipple procedure (pancreaticoduodenectomy) is a complex surgery for periampullary and pancreatic head cancers.
• Establishing regional centers is crucial for managing complex gastrointestinal diseases.

Purpose of the Study:

• To retrospectively review the outcomes of Whipple procedures performed at Aga Khan University Hospital between 1986 and December 2009.
• To assess the morbidity and mortality rates of pancreaticoduodenectomy in a Pakistani population.

Main Methods:

• Retrospective review of patient case notes.
• Data extraction included demographics, clinical and laboratory findings, operative details, and postoperative outcomes.
• Surgical mortality was defined as death within 30 days of the procedure.

Main Results:

• 121 patients underwent successful pancreaticoduodenectomy, with adenocarcinoma being the most common pathology.
• Postoperative morbidity occurred in 54% of patients, with chest infection, delayed gastric emptying, and pancreatic anastomotic leak being most frequent.
• The surgical mortality rate was 10% (12 perioperative deaths).

Conclusions:

• This series represents the largest consecutive pancreaticoduodenectomy series reported in Pakistan.
• Morbidity and mortality rates are comparable to international centers with similar annual case volumes.
• There is a need for specialized regional centers to enhance care for patients undergoing complex surgical procedures.