title: One hundred and seventy-eight consecutive pancreatoduodenectomies without mortality: role of the multidisciplinary approach.
abstract: BACKGROUND
  Pancreatoduodenectomy offers the only chance of cure for patients with periampullary cancers. This, however, is a major undertaking in most patients and is associated with a significant morbidity and mortality. A multidisciplinary approach to the workup and follow-up of patients undergoing pancreatoduodenectomy was initiated at our institution to improve the diagnosis, resection rate, mortality and morbidity. We undertook the study to assess the effect of this approach on diagnosis, resection rates and short-term outcomes such as morbidity and mortality.
  
  
  METHODS
  A prospective database of patients presenting with periampullary cancers to a single surgeon between April 2004 and April 2010 was reviewed. All cases were discussed at a multidisciplinary meeting comprising surgeons, gastroenterologists, radiologists, oncologists, radiation oncologists, pathologists and nursing staff. A standardized investigation and management algorithm was followed. Complications were graded according to the Clavien-Dindo classification.
  
  
  RESULTS
  A total of 295 patients with a periampullary lesion were discussed and 178 underwent pancreatoduodenectomy (resection rate 60%). Sixty-one patients (34%) required either a vascular or an additional organ resection. Eighty-nine patients experienced complications, of which the commonest was blood transfusion (12%). Thirty-four patients (19%) had major complications, i.e. grade 3 or above. There was no in-hospital, 30-day or 60-day mortality.
  
  
  CONCLUSIONS
  Pancreatoduodenectomy can safely be performed in high-volume centers with very low mortality. The surgeon's role should be careful patient selection, intensive preoperative investigations, use of a team approach, and an unbiased discussion at a multidisciplinary meeting to optimize the outcome in these patients.
authors.affiliation: Upper Gastrointestinal Surgical Unit, University of Sydney, Royal North Shore Hospital, St Leonards, NSW 2065, Sydney, Australia. jaswinder.samra@optusnet.com.au
authors.forename: Jaswinder S
authors.initials: JS
authors.lastname: Samra
authors.forename: Raul Alvarado
authors.initials: RA
authors.lastname: Bachmann
authors.forename: Julian
authors.initials: J
authors.lastname: Choi
authors.forename: Anthony
authors.initials: A
authors.lastname: Gill
authors.forename: Michael
authors.initials: M
authors.lastname: Neale
authors.forename: Vikram
authors.initials: V
authors.lastname: Puttaswamy
authors.forename: Cameron
authors.initials: C
authors.lastname: Bell
authors.forename: Ian
authors.initials: I
authors.lastname: Norton
authors.forename: Sarah
authors.initials: S
authors.lastname: Cho
authors.forename: Steven
authors.initials: S
authors.lastname: Blome
authors.forename: Ritchie
authors.initials: R
authors.lastname: Maher
authors.forename: Sivakumar
authors.initials: S
authors.lastname: Gananadha
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Hugh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D010348:Patient Care Team; D011183:Postoperative Complications / Q000209:etiology; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult