title: Pancreaticoduodenectomy: a 20-year experience in 516 patients.
abstract: OBJECTIVE
  Pancreaticoduodenectomy (PD) is a safe procedure for a variety of periampullary conditions.
  
  
  METHODS
  Retrospective review of a prospectively collected database.
  
  
  METHODS
  Academic tertiary care hospital.
  
  
  METHODS
  A total of 516 consecutive patients who underwent PD.
  
  
  METHODS
  Patient outcomes and survival factors.
  
  
  RESULTS
  Pathological examination demonstrated 57% periampullary cancers, 22% chronic pancreatitis, 12% cystic neoplasms, 4% islet cell neoplasms, and 5% other. Fifty-one percent of patients underwent pylorus preservation. Median operating time was 5 hours; blood loss, 1300 mL; and transfusion requirement, 1.5 U. Postoperative complications occurred in 43% of patients, including cardiopulmonary events (15%), fistula (9%), delayed gastric emptying (7%), and sepsis (6%). Additional surgery was required in 3% of patients, most commonly because of bleeding. Perioperative mortality was 3.9% overall but only 1.8% in patients with chronic pancreatitis; 25% of patients who died had preoperative complications associated with their periampullary condition. Three-year survival was 15% after resection for pancreatic cancer, 42% for duodenal cancer, 53% for ampullary cancer, and 62% for bile duct cancer. Univariate predictors of long-term survival in patients with periampullary adenocarcinoma included elevated glucose levels, liver function test results, abnormal tumor markers, blood loss, transfusion requirement, type of operation, and pathologic findings (periampullary adenocarcinoma type, differentiation, and margin and node status). Multivariate predictors were serum total bilirubin level, blood loss, operation type, diagnosis, and lymph node status.
  
  
  CONCLUSIONS
  Pancreaticoduodenectomy continues to be associated with considerable morbidity. With careful patient selection, PD can be performed safely. Long-term survival in patients with periampullary adenocarcinoma can be predicted by preoperative laboratory values, intraoperative factors, and pathologic findings.
authors.affiliation: Department of Surgery, University Hospital, Indiana University School of Medicine, Indianapolis, USA. maxschmi@iupui.edu
authors.forename: C Max
authors.initials: CM
authors.lastname: Schmidt
authors.forename: Emilie S
authors.initials: ES
authors.lastname: Powell
authors.forename: Constantin T
authors.initials: CT
authors.lastname: Yiannoutsos
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Howard
authors.forename: Eric A
authors.initials: EA
authors.lastname: Wiebke
authors.forename: Chad A
authors.initials: CA
authors.lastname: Wiesenauer
authors.forename: Joel A
authors.initials: JA
authors.lastname: Baumgardner
authors.forename: Oscar W
authors.initials: OW
authors.lastname: Cummings
authors.forename: Lewis E
authors.initials: LE
authors.lastname: Jacobson
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Broadie
authors.forename: David F
authors.initials: DF
authors.lastname: Canal
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goulet
authors.forename: Eardie A
authors.initials: EA
authors.lastname: Curie
authors.forename: Higinia
authors.initials: H
authors.lastname: Cardenes
authors.forename: John M
authors.initials: JM
authors.lastname: Watkins
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Loehrer
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
authors.forename: James A
authors.initials: JA
authors.lastname: Madura
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D001650:Bile Duct Neoplasms / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D004379:Duodenal Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D016577:Pancreaticoduodenectomy / Q000379:methods; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies