title: Pancreatic surgery: evolution at a high-volume center.
abstract: BACKGROUND
  Advances in imaging, minimally invasive techniques, and regionalization have changed pancreatic surgery. Therefore, the aims of this report are to determine whether the pancreatic operations or the spectrum of disease have evolved at a high-volume center.
  
  
  METHODS
  From 1996 through 2009, 2,004 pancreatic operations were performed at Indiana University Hospital. The operations, pathology, and outcomes for 1996-2003 were compared with 2004-2009.
  
  
  RESULTS
  In 2004-2009, more operations/year were performed (215 vs 89; P < .01) and patients were older (58.8 years vs 55.8 years; P < .01). In recent years, more pancreatoduodenectomies (55.0% vs 50.4%) and fewer pancreatojejunostomies (6.2% vs 12.6%) and Beger/Frey procedures (2.6% vs 4.8%) were performed (P < .05). In 2004-2009, pylorus preservation (81.1% vs 64.4%), laparoscopic distal pancreatectomy (33.9% vs 0%), and splenic preservation (25.3% vs 2.2%) were carried out more frequently (P < .001). Pathology review revealed more tumors (68.8% vs 60.4%) and less pancreatitis (29.2% vs 34.4%; P < .01). Thirty-day mortality improved from 2.5% to 1.8%.
  
  
  CONCLUSIONS
  At a high-volume pancreatic surgery center, the number and age of the patients, the percentage of pancreatic resections, preservation of the pylorus and spleen as well as laparoscopic procedures, and the percentage of patients with tumors all have increased, whereas the outcomes continued to improve.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Ziegler
authors.forename: Attila
authors.initials: A
authors.lastname: Nakeeb
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.forename: C Max
authors.initials: CM
authors.lastname: Schmidt
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Bishop
authors.forename: Jose
authors.initials: J
authors.lastname: Moreno
authors.forename: Jesus M
authors.initials: JM
authors.lastname: Matos
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Zyromski
authors.forename: Michael G
authors.initials: MG
authors.lastname: House
authors.forename: James A
authors.initials: JA
authors.lastname: Madura
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Howard
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
mesh_terms: D005260:Female; D006801:Humans; D007196:Indiana; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000706:statistics & numerical data*; D010182:Pancreatic Diseases / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*