One hundred and seventy-eight consecutive pancreatoduodenectomies without mortality: Role of the multidisciplinary approach

Jaswinder S. Samra, Raul Alvarado Bachmann, Julian Choi, Anthony Gill, Michael Neale, Vikram Puttaswamy, Cameron Bell, Ian Norton, Sarah Cho, Steven Blome, Ritchie Maher, Sivakumar Gananadha, Thomas J. Hugh

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)

Abstract

Background: Pancreatoduodenectomy offers the only chance of cure for patients with periampullary cancers. This, however, is a major undertaking in most patients and is associated with a signifcant morbidity and mortality. A multidisciplinary approach to the workup and follow-up of patients undergoing pancreatoduodenectomy was initiated at our institution to improve the diagnosis, resection rate, mortality and morbidity. We undertook the study to assess the effect of this approach on diagnosis, resection rates and short-term outcomes such as morbidity and mortality.

Methods: A prospective database of patients presenting with periampullary cancers to a single surgeon between April 2004 and April 2010 was reviewed. All cases were discussed at a multidisciplinary meeting comprising surgeons, gastro-enterologists, radiologists, oncologists, radiation oncologists, pathologists and nursing staff. A standardized investigation and management algorithm was followed. Complications were graded according to the Clavien-Dindo classifcation.

Results: A total of 295 patients with a periampullary lesion were discussed and 178 underwent pancreatoduodenectomy (resection rate 60%). Sixty-one patients (34%) required either a vascular or an additional organ resection. Eighty-nine patients experienced complications, of which the commonest was blood transfusion (12%). Thirty-four patients (19%) had major complications, i.e. grade 3 or above. There was no in-hospital, 30-day or 60-day mortality.

Conclusions: Pancreatoduodenectomy can safely be performed in high-volume centers with very low mortality. The surgeon's role should be careful patient selection, intensive preoperative investigations, use of a team approach, and an unbiased discussion at a multidisciplinary meeting to optimize the outcome in these patients.

Original languageEnglish
Pages (from-to)415-421
Number of pages7
JournalHepatobiliary and Pancreatic Diseases International
Volume10
Issue number4
DOIs
Publication statusPublished - Aug 2011
Externally publishedYes

Keywords

  • pancreatoduodenectomy
  • multidisciplinary
  • vascular resection

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