title: Relationship between surgical volume and clinical outcome: should pediatric surgeons be doing pancreaticoduodenectomies?
abstract: BACKGROUND
  The relationship between surgical volume and clinical outcome is well established in adult pancreatic surgery. We examined whether this relationship is applicable in pediatric surgery, given that very few cases are done regularly by pediatric surgeons even at tertiary centers.
  
  
  METHODS
  A retrospective analysis of all patients who underwent pancreaticoduodenectomies between 1993 and 2003 was done. Comparisons were made to the largest recent series of pancreaticoduodenectomies in the adult literature.
  
  
  RESULTS
  With the age at presentation from 9 to 17 years, 5 patients were identified. Mean operative time was 451 minutes with a median of 363 minutes compared with the mean and median in the adult literature of 420 minutes. Clean margins were obtained in all patients compared with 71% in adults. Mean follow-up was 35 months. All patients are alive, with 1 patient who has underwent subsequent resections for local recurrence.
  
  
  CONCLUSIONS
  Although 5 consecutive cases of pancreaticoduodenectomies represent very low volume compared with high-volume adult centers, minimal difference in operative time, length of stay, and mortality (none) were observed in this series. Therefore, unlike adults, particular case volume in the pediatric population may not be a significant factor because of the nature of pancreatic pathology, patient characteristics, and hospital and surgical environment.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
authors.forename: Roshni
authors.initials: R
authors.lastname: Dasgupta
authors.forename: Peter C W
authors.initials: PC
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002648:Child; D002983:Clinical Competence; D018283:Cystadenocarcinoma, Papillary / Q000601:surgery; D005500:Follow-Up Studies; D013502:General Surgery / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D033183:Interdisciplinary Communication; D007432:Intraoperative Period; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000601:surgery; D018358:Neuroendocrine Tumors / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000706:statistics & numerical data*; D010348:Patient Care Team; D010372:Pediatrics / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012509:Sarcoma / Q000188:drug therapy / Q000556:secondary / Q000601:surgery; D012512:Sarcoma, Ewing / Q000188:drug therapy / Q000556:secondary / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents