Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy.
OBJECTIVE
Advances in specialized centers for pancreatic diseases have improved surgical morbidity and outcome. In the past, postoperative local complications (pancreatic fistulae) were causing most of the mortality. Now, more patients experience postoperative complications related to their comorbidity.


METHODS
To report a prospective audit of a single center's experience with pancreatic resection during an 8-year period.


METHODS
Tertiary referral center focused on pancreatic diseases.


METHODS
Six hundred seventeen consecutive patients underwent pancreatectomy between November 1, 1993, and August 31, 2001. The series included 468 pancreatic head resections (76%), 25 total pancreatectomies (4%), 88 left-sided resections (14%), and 36 others (6%).


METHODS
Morbidity after pancreatic resection.


RESULTS
Postoperative in-hospital mortality was 1.6%, and the additional operation rate was 4.1%. Four patients died of surgical complications and 6 of systemic complications. Systemic morbidity was 18% and consisted primarily of cardiopulmonary complications (13%). The most frequent postoperative complication was delayed gastric emptying (14%), which caused significant prolongation of the hospital stay. No patients died of a postoperative pancreatic fistula, which occurred in 3.2%, and no completion pancreatectomies were necessary.


CONCLUSIONS
Pancreatic resections can be performed with considerable safety and a low rate of pancreatic complications. More patients die of systemic complications than in the past, which increases the demand for precise preoperative patient selection. Completion pancreatectomy should no longer be considered in patients with a pancreatic fistula.
Büchler
Markus W
MW
Department of Visceral and Transplantation Surgery, University of Bern, Inselspital, Switzerland. markus_buechler@med.uni-heidelberg.de
Wagner
Markus
M
Schmied
Bruno M
BM
Uhl
Waldemar
W
Friess
Helmut
H
Z'graggen
Kaspar
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects*; D010182:Pancreatic Diseases / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013557:Switzerland / Q000453:epidemiology