title: A selective approach to the surgical management of periampullary cancer patients and its outcome.
abstract: BACKGROUND
  Pancreaticoduodenectomy is a high risk, complex, technically challenging operation associated with significant perioperative morbidity and mortality. This study on the surgical management of periampullary cancer patients is based on our experience in a period of nearly 13 years.
  
  
  METHODS
  The study was conducted on two groups of patients: group A included 42 patients who were treated between January 2000 and September 2005 and group B included 134 patients who were treated between October 2005 to October 2012. Preoperative, intraoperative and postoperative details of all these patients were collected, tabulated and analyzed to assess the impact of the selective approach introduced in the department with effect from October 2005.
  
  
  RESULTS
  Intraoperative details revealed highly significant differences in the management of the two groups of patients in respect of operative time (250.4 vs 126.6 minutes; P<0.001), operative blood loss (1070.2 vs 414.9 mL; P<0.001) and intraoperative blood transfusion (1.4 vs 0.2 units; P<0.001). Variations between the two groups in the frequency of complications were found to be statistically insignificant. However, the difference between the two groups in the overall morbidity of patients (47.6% vs 26.1%; P=0.009) and the length of their hospital stay (11.8 vs 7.8 days; P<0.001) were significant.
  
  
  CONCLUSIONS
  A selective approach applied to the surgical management of periampullary cancer patients is a step in the right direction.
authors.affiliation: Department of Surgical Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India. omarjshah@yahoo.com.
authors.forename: Omar J
authors.initials: OJ
authors.lastname: Shah
authors.forename: Irfan
authors.initials: I
authors.lastname: Robbani
authors.forename: Parveen
authors.initials: P
authors.lastname: Shah
authors.forename: Sadaf A
authors.initials: SA
authors.lastname: Bangri
authors.forename: Irfan J
authors.initials: IJ
authors.lastname: Khan
authors.forename: Mohammad Y
authors.initials: MY
authors.lastname: Bhat
authors.forename: Manmohan
authors.initials: M
authors.lastname: Singh
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D001652:Bile Ducts / Q000601:surgery; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000601:surgery*; D004386:Duodenum / Q000601:surgery; D005260:Female; D015390:Gastric Bypass / Q000379:methods; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods*; D010193:Pancreaticojejunostomy / Q000379:methods; D018579:Patient Selection