The association between higher volume and better outcome for pancreatoduodenectomy

Abstract

Few elective surgical procedures are associated with higher operative risks than pancreatoduodenectomy. In the past, the operation was burdened by perioperative mortality rates exceeding 20% and a considerably higher morbidity rate [ 1 x 1 Mongé, J.J., Judd, E.S., and Gage, R.P. Radical pancreaticoduodenectomy: A 22‐year experience with the complications, mortality rate, and survival rate. Ann Surg. 1965; 160: 711–716 Crossref | Scopus (127) | Google Scholar See all References , 2 x 2 Lansing, P.B., Blalock, J.B., and Ochsner, J.L. Pancreaticoduodenectomy: a retrospective review. 1949–1969. Ann Surg. 1972; 38: 79–86 Google Scholar See all References , 3 x 3 Gilsdorf, R.B. and Spanos, P. Factors influencing morbidity and mortality in pancreaticoduodenecomy. Ann Surg. 1973; 177: 332–337 Crossref | PubMed | Google Scholar See all References ]. In a patient series collected between 1977 and 1986 in the West Midlands, UK, Bramhall and colleagues [ 4 x 4 Bramhall, S.R., Allum, W.H., Jonas, A.G., Allwood, A., and Cummins, C. Neoptolomos JP. Treatment and survival in 13560 patients with pancreatic cancer, and incidence of the disease, in the West Midlands; an epidemiological study. Br J Surg. 1995; 82: 111–115 Crossref | PubMed | Scopus (448) | Google Scholar See all References 4 ] found a 30‐day mortality rate of 28%, and a recent survey by the Commission on Cancer in USA demonstrated that mortality rates higher than 10% remain common [ 5 x 5 Janes, R.H., Niederhuber, J.E., Chmiel, J.S., Winchester, D.P., and Ocwieja, K.C. Karmell LH. National patterns of care for pancreatic cancer: results of a survey by the. Commission Cancer Ann Surg. 1996; 223: 261–272 Crossref | Scopus (149) | Google Scholar See all References 5 ]. However, in later years several experienced centres have reported markedly improved results of less than 5% [ 6 x 6 Geer, R.H. and Brennan, M.F. Prognostic indicators for survival after resection of pancreatic adenocarcinoma. Am J Surg. 1993; 165: 68–72 Abstract | Full Text PDF | PubMed | Scopus (685) | Google Scholar See all References , 7 x 7 Pellegrini, C.A., Heck, C.F., Raper, S., and Way, L.W. An analysis of the reduced morbidity and mortality rates after pancreaticoduodenectomy. Arch Surg. 1989; 124: 778–781 Crossref | PubMed | Scopus (185) | Google Scholar See all References , 8 x 8 Trede, M., Schwall, G., and Saeger, H.D. Survival after pancreaticoduodenectomy: 118 consecutive resections without an operative mortality. Ann Surg. 1990; 211: 447–458 Crossref | PubMed | Scopus (1069) | Google Scholar See all References , 9 x 9 Ihse, I., Andersson, H., and Andrén‐Sandberg, Å. Total pancreatectomy for cancer of the pancreas: Is it appropriate?. World J Surg. 1996; 20: 288–294 Crossref | PubMed | Scopus (107) | Google Scholar See all References ]. In a nationwide study from the Netherlands, 46% of the pancreatoduodenectomies were performed in hospitals doing fewer than five operations per year and with a hospital mortality rate of 16%. In centres doing more than 25 resections per year, the corresponding figure was 1.5% [ 10 x 10 Gouma, D.J., de Wit, L.T., van Berge Henegouwen, M.I., van Gulik, T.M., and Obertop, H. Ziekenhuiservaring en ziekenhuissterfte ma partiele pancreaticoduodenectomie. Ned Tijdschr Geneeskd. 1997; 141: 1738–1741 PubMed | Google Scholar See all References 10 ].