Standards for pancreatic resection in the 1990s.
OBJECTIVE
To describe the current indications and operative outcomes of pancreatic resection.


METHODS
Retrospective case series.


METHODS
Referral practice in a university hospital.


METHODS
Two hundred thirty-one consecutive patients undergoing pancreatoduodenectomy (PD), distal pancreatectomy (DP), or total pancreatectomy (TP) over a 44-month period. Their ages ranged from 16 to 85 years, with a mean of 54 years; 20% of the patients were 70 years old or older.


METHODS
Mortality, complications, and length of hospital stay.


RESULTS
Operative mortality was 0.4% (one death following DP); there were no deaths in 142 PDs or in 18 TPs. The most common complication following PD was delayed gastric emptying. Pancreatic fistula occurred in 6.3% of PD and in 9.8% of DP patients. Overall, 58% of PD, 80% of DP, and 78% of TP patients had no complications. The mean +/- SD length of hospital stay was 15 +/- 7, 10 +/- 5, and 15 +/- 6 days for PD, DP, and TP, respectively. Reoperation for any cause was necessary in only 1.2% (3/231). The most frequent indication for PD was pancreatic cancer (36%) followed by chronic pancreatitis (26%); for DP it was chronic pancreatitis (28%) and cystic neoplasms (27%); and for TP, chronic pancreatitis (55%). Newer indications for pancreatic resection included mucinous ductal ectasia and intraductal papillary tumors (eight cases, 4%) and metastatic tumors (eight cases, 4%).


CONCLUSIONS
Current indications for pancreatic resection have expanded. These procedures are associated with a low risk for death and postoperative complications when performed in a high-volume setting.
Fernández-del Castillo
C
C
Department of Surgery, Massachusetts General Hospital, Boston, Mass.
Rattner
D W
DW
Warshaw
A L
AL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001900:Boston / Q000453:epidemiology; D002908:Chronic Disease; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000592:standards*; D010183:Pancreatic Ducts / Q000473:pathology / Q000601:surgery; D010185:Pancreatic Fistula / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000592:standards; D010195:Pancreatitis / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome