Factors influencing improved patient outcomes after pancreaticoduodenectomy--a single institute experience of 209 consecutive patients in a decade.
OBJECTIVE
Postoperative mortality and morbidity after pancreaticoduodenectomy (PD) remain major issues today and we discuss the factors influencing improved patient outcome after PD.


METHODS
Two hundred and nine patients underwent PD between 2001 and 2010 In our hospital. The first 58 cases between 2001 and 2004 were named Group A and the latter 151 cases between 2005 and 2010 were named Group B. Then, we compared the intraoperative outcomes and postoperative mortality and major morbidities between two groups.


RESULTS
Between 2005 and 2010, the annual volume of PD has been over 20 continuously. In Group A, 58 PDs were performed by five surgeons but in Group B, the main surgeon performed 131 of 151 (86.8%) PDs. The mortality rate in Group A (1.7%) was not different from that in Group B (1.3%). The frequency of patients with all postoperative morbidities in Group B (43.7%) was significantly lower than that in Group A (70.7%) (p=0.00048). The frequencies of DGE and SSI in Group B (8.6%, 23.8%) were significantly lower than those in Group A (25.8%, 37.9%) (p=0.010, p=0.042).


CONCLUSIONS
The increases of surgeon and hospital volume and the change of the mode of PD were factors influencing improved patient outcomes after PD.
Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan. noda164@hotmail.co.jp
Hiroshi
H
Noda
Hidenori
H
Kamiyama
Takaharu
T
Kato
Fumiaki
F
Watanabe
Nao
N
Kakizawa
Nobuyuki
N
Toyama
Fumio
F
Konishi
D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D007564:Japan; D008297:Male; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D058996:Quality Improvement; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome