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Standards for pancreatic resection in the 1990s
C Fernández-del Castillo1, D W Rattner, A L Warshaw
1Department of Surgery, Massachusetts General Hospital, Boston, Mass.
Archives of Surgery (Chicago, Ill. : 1960)
|March 1, 1995
Summary
Pancreatic resections, including pancreatoduodenectomy, distal pancreatectomy, and total pancreatectomy, show expanded indications and low operative mortality. These complex surgeries have favorable outcomes when performed in high-volume centers.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Hepatobiliary Surgery
Background:
- Pancreatic resections are complex surgical procedures.
- Indications and outcomes for these surgeries require ongoing evaluation.
- High-volume centers are crucial for optimizing surgical results.
Purpose of the Study:
- To delineate the current spectrum of indications for pancreatic resection.
- To analyze the operative outcomes, including mortality and complications, of pancreatic resections.
- To assess the safety and efficacy of pancreatoduodenectomy (PD), distal pancreatectomy (DP), and total pancreatectomy (TP).
Main Methods:
- A retrospective case series of 231 consecutive patients undergoing PD, DP, or TP.
- Data collected over a 44-month period at a university hospital referral practice.
- Outcomes analyzed included operative mortality, complication rates, and length of hospital stay.
Main Results:
- Overall operative mortality was low at 0.4%, with no deaths in 142 PDs or 18 TPs.
- Common indications included pancreatic cancer, chronic pancreatitis, and cystic neoplasms.
- Complication rates varied, with delayed gastric emptying most frequent after PD; pancreatic fistula occurred in 6.3% of PD and 9.8% of DP.
- Most patients experienced no complications (58% PD, 80% DP, 78% TP), and reoperation rates were low (1.2%).
Conclusions:
- Indications for pancreatic resection have broadened beyond traditional diagnoses.
- Pancreatic resections are associated with low mortality and acceptable complication rates.
- Performing these procedures in high-volume settings is critical for achieving optimal outcomes.