Quality standards in 480 pancreatic resections: a prospective observational study.

Area of Science:

• Surgery
• Gastroenterology
• Oncology

Background:

• Pancreatic resection is a critical treatment for periampullary tumors, yet associated with significant morbidity and mortality.
• Establishing quality standards for these complex procedures is essential.
• International classifications, such as Clavien-Dindo and the International Study Group for Pancreatic Surgery (ISGPS), aid in standardizing complication assessment.

Purpose of the Study:

• To describe the morbidity and mortality associated with 480 pancreatic resections using ISGPS and Clavien-Dindo classifications.
• To establish a quality benchmark for pancreatic resections in the local setting.
• To compare the outcomes of pancreatoduodenectomy reconstruction using pancreaticogastrostomy versus pancreaticojejunostomy.

Main Methods:

• Retrospective analysis of 480 pancreatic resections, including duodenopancreatectomies, distal pancreatectomies, and others.
• Classification of complications using the Clavien-Dindo system and ISGPS criteria.
• Comparative analysis of reconstruction methods: pancreaticogastrostomy versus pancreaticojejunostomy.

Main Results:

• Overall morbidity for duodenopancreatectomy was 62%, with 25.9% experiencing severe complications (Clavien ≥ III).
• Reconstruction with pancreaticojejunostomy resulted in 71.2% morbidity (34.4% severe), 17.5% reinterventions, and 3.3% mortality.
• Reconstruction with pancreaticogastrostomy showed significantly lower morbidity (51%, 15.4% severe), fewer reinterventions (6.4%), and similar mortality (3.2%).

Conclusions:

• The study series meets established quality criteria for pancreatic resections.
• Pancreaticogastrostomy reconstruction is associated with a significant reduction in complication rates, severity, pancreatic fistulas, and reinterventions compared to pancreaticojejunostomy.