Is there an alternative to centralization for pancreatic resection in New Zealand?
BACKGROUND
Internationally pancreatic surgery has become increasingly centralized; however, geographical and population distribution within New Zealand (NZ) limits the practicalities of such an approach. The aim of this study was to review the short-term outcomes of patients undergoing pancreatic surgery by a single hepato-pancreato-biliary trained surgeon in a centre that would meet the minimum criteria set by the NZ National Standards but not necessarily the definition of a high-volume surgeon/centre.


METHODS
A retrospective review of consecutive patients undergoing pancreatic resection within an enhanced recovery programme by a single surgeon between March 2005 and April 2013. Primary outcomes were 30-day morbidity and 90-day mortality.


RESULTS
A total of 156 patients who underwent a pancreatic resection were included. Eighty-two (53%) patients underwent a pancreaticoduodenectomy. Forty-seven (30%) underwent a left pancreatectomy. Overall, 30-day morbidity was 64% and overall 90-day mortality was 2.6%. Overall median length of stay was 11 (3-140) days.


CONCLUSIONS
Acceptable outcomes have been achieved for patients undergoing pancreatic resection within a centre that meets the criteria proposed by the NZ National Standards for treatment of pancreatic cancer.
Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand.
Todd
T
Hore
Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand.
Megan
M
Thomas
Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand.
Lisa
L
Brown
Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand.
Magdalena
M
Sakowska
Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand.
Saxon
S
Connor
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D010180:Pancreatectomy / Q000706:statistics & numerical data*; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult
pancreatectomy; pancreaticoduodenectomy; pancreaticojejunostomy