Seven years experience of pancreaticoduodenectomy at Sawanpracharak Hospital.
BACKGROUND
Pancreaticoduodenectomy is a major procedure with significant mortality and morbidity. Pancreaticoduodenectomy is a safe procedure for a variety of periampullary conditions at Sawanpracharak Hospital.


OBJECTIVE
To evaluate complications, morbidity, and mortality. The effects of clinical and variables related to patient mortality.


METHODS
Retrospective medical records review of 52 patients who underwent pancreaticoduodenectomy at Sawanpracharak Hospital between February 2000 and November 2006 was conducted. Of these, 12 patients who died after pancreaticoduodenectomy were studied.


RESULTS
Of 52 cases, 29 males and 23 females, the median age was 64 years (age range, 32-82 years). Median operative time was 3.70 hours (range, 2.0-9.5 hours). Pathological examination demonstrated 38.46% ampullary cancer 26.92% pancreatic cancer, 1.92% duodenal cancer, 11.54% periampullary cancer, 3.85% gastric cancer, 1.92% gastrointestinal stromal tumor, 5.77% chronic pancreatitis, 1.92% cystadenoma of pancreas, 1.92 chronic gastric ulcer, 1.92% leiomyoma of duodenum, and 3.85% no pathologic report. Fifty percent of patients underwent pylorus preservation pancreaticoduodenectomy. Postoperative complications occurred in 40.38% of patients, including intraabdominal abscess (19.05%), pancreatic fistula (14.29%), bowel fistula (9.52%), internal bleeding (9.52,%), sepsis (9.52%), superior mesenteric occlusion (4.76%), bile fistula (4.76%), cholangitis (4.76%), acute renal failure (14.29%), pneumonia (4.76%), acute myocardial infarction (4.76%), and additional surgery was required in 13.46% of patients. Overall perioperative mortality was 23.08% with only one patient with benign disease (chronic pancreatitis) died postoperatively. Underlying medical disease conditions did not influence postoperative morbidity or mortality. Natures of surgical complications were indicated as causes of significant higher mortality. The median follow-up for patients was 3.37 months (range, 0.5-65.7 months, mean 8.71 +/- 13.66 months).


CONCLUSIONS
Pancreaticoduodenectomy still causes considerable morbidity and mortality. With careful patient selection, preoperative assessment of respectability, surgical technique, critical care anesthesia, and postoperative care, pancreaticoduodenectomy can be performed safely and improve the results to an acceptable level.
Department of Surgery, Sawanpracharak Hospital, Nakhon Sawan, Thailand.
Suchart
S
Wipassakornwarawut
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004378:Duodenal Diseases / Q000601:surgery*; D004386:Duodenum / Q000473:pathology / Q000601:surgery; D005260:Female; D005767:Gastrointestinal Diseases / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology / Q000601:surgery; D010182:Pancreatic Diseases / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D011300:Preoperative Care; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome