Low mortality rate in 97 consecutive pancreaticoduodenectomies: the experience of a group.
BACKGROUND
Pancreaticoduodenectomy is the procedure of choice for resectable cancer of the periampullary region. These tumors account for 4% of deaths from cancer, being referred to as one of the lowest survival rates at 5 years. Surgery remains a complex procedure with substantial morbidity and mortality. Despite reports of up to 30% mortality rates, in centers of excellence it have been identified as less than 5%. Recent studies show that pancreaticojejunostomy represents the "Achilles' heel" of the procedure.


OBJECTIVE
To evaluate the post-operative 30 days morbidity and mortality rates.


METHODS
Retrospective analysis of 97 consecutive resected patients between July, 2000 and December, 2012. All patients were managed by the same group, and data were obtained from specific database service. The main objective was to evaluate the 30-day mortality rate, but we also studied data of surgical specimen, need for vascular resection and postoperative complications (gastric stasis, pancreatic fistula, pneumonia and reoperation rate).


RESULTS
Thirty-day mortality rate was 2.1% (two patients). Complete resection with no microscopic residual tumor was obtained in 93.8% of patients, and in 67.3% of cases pathology did not detected metastatic nodes. Among postoperative complications were reported 6% of prolonged gastric stasis, 10.3% of pneumonia, 10.3% of pancreatic fistula and 1% of infection in the drain pathway. Two patients underwent reoperation due to bleeding and infected hematoma caused by pancreatic fistula, and another for intestinal obstruction because of adhesions at postoperative day 12.


CONCLUSIONS
The pancreaticoduodenectomy as treatment procedure for periampullary cancers has a low morbidity and mortality rate in services with experience in Hepato-Pancreato-Biliary surgery, remaining as first-line treatment in resectable patients.
Universidade Federal de Ciências de Saúde de Porto Alegre, UFCSPA ? Departamento de Clínica Cirúrgica, Porto Alegre, RS, Brasil.
Paulo Roberto Ott
PR
Fontes
Universidade Federal de Ciências de Saúde de Porto Alegre, UFCSPA ? Departamento de Clínica Cirúrgica, Porto Alegre, RS, Brasil.
Fábio Luiz
FL
Waechter
Universidade Federal de Ciências de Saúde de Porto Alegre, UFCSPA ? Departamento de Clínica Cirúrgica, Porto Alegre, RS, Brasil.
Mauro
M
Nectoux
Universidade Federal de Ciências de Saúde de Porto Alegre, UFCSPA ? Departamento de Clínica Cirúrgica, Porto Alegre, RS, Brasil.
José Artur
JA
Sampaio
Universidade Federal de Ciências de Saúde de Porto Alegre, UFCSPA ? Departamento de Clínica Cirúrgica, Porto Alegre, RS, Brasil.
Uirá Fernandes
UF
Teixeira
Universidade Federal de Ciências de Saúde de Porto Alegre, UFCSPA ? Departamento de Clínica Cirúrgica, Porto Alegre, RS, Brasil.
Luiz
L
Pereira-Lima
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D012189:Retrospective Studies; D016896:Treatment Outcome