title: Pancreaticoduodenectomy in a tertiary referral center in Saudi Arabia: a retrospective case series.
abstract: BACKGROUND
  Perioperative outcome of pancreaticoduodenectomy is related to work load volume and to whether the procedure is carried out in a tertiary specialized hepato-pancreatico-biliary (HPB) unit.
  
  
  OBJECTIVE
  To evaluate the perioperative outcome associated with pancreaticoduodenectomy in a newly established HPB unit.
  
  
  METHODS
  Analysis of 32 patients who underwent pancreaticoduodenectomy (PD) for benign and malignant indications.
  
  
  METHODS
  Retrospective collection of data on preoperative, intraoperative and postoperative care of all patients undergoing PD.
  
  
  RESULTS
  Thirty-two patients (16 male and 16 female) with a mean age of 59.5±12.7years were analyzed. The overall morbidity rate was high at 53%. The most common complication was wound infection (n=11; 34.4%). Pancreatic and biliary leaks were seen in 5 (15.6%) and 2 (6.2%) cases, respectively, while delayed gastric emptying was recorded in 7 (21.9%). The female sex was not associated with increased morbidity. Presence of co-morbid illness, pylorus-preserving PD, intra-operative blood loss ⩾1L, and perioperative blood transfusion were not associated with significantly increased morbidity. The overall hospital mortality was 3.1% and the cumulative overall (OS) and disease free survival (DFS) at 1year were 80% and 82.3%, respectively. The cumulative overall survival for pancreatic cancer vs ampullary tumor at 1year were 52% vs 80%, respectively.
  
  
  CONCLUSIONS
  PD is associated with a low risk of operative death when performed by specialized HPB surgeons even in a tertiary referral hospital. However, the postoperative morbidity rate remains high, mostly due to wound infection. Further improvement by reducing postoperative infection may help curtail the high postoperative morbidity.
authors.affiliation: Section of Hepato-pancreatico-biliary Surgery, King Fahad Specialist Hospital, Dammam 31444, Eastern Province, Saudi Arabia. amraziz055@yahoo.com
authors.forename: Amr Mostafa
authors.initials: AM
authors.lastname: Aziz
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abbas
authors.forename: Hisham
authors.initials: H
authors.lastname: Gad
authors.forename: Osama H
authors.initials: OH
authors.lastname: Al-Saif
authors.forename: Kam
authors.initials: K
authors.lastname: Leung
authors.forename: Abdul-Wahed N
authors.initials: AW
authors.lastname: Meshikhes
mesh_terms: D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D050500:Pancreatitis, Chronic / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012529:Saudi Arabia / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*