title: Retrospective analyses of trends in pancreatic surgery: indications, operative techniques, and postoperative outcome of 1,120 pancreatic resections.
abstract: BACKGROUND
  Hospital volume, surgeons' experience, and adequate management of complications are factors that contribute to a better outcome after pancreatic resections. The aim of our study was to analyze trends in indications, surgical techniques, and postoperative outcome in more than 1,100 pancreatic resections.
  
  
  METHODS
  One thousand one hundred twenty pancreatic resections were performed since 1994. The vast majority of operations were performed by three surgeons. Perioperative data were documented in a pancreatic database. For the purpose of our analysis, the study period was sub-classified into three periods (A 1994 to 2001/n = 363; B 2001 to 2006/n = 305; C since 2007 to 2012/n = 452).
  
  
  RESULTS
  The median patient age increased from 51 (A) to 65 years (C; P < 0.001). Indications for surgery were pancreatic/periampullary cancer (49%), chronic pancreatitis (CP; 33%), and various other lesions (18%). About two thirds of the operations were pylorus-preserving pancreaticoduodenectomies. The frequency of mesenterico-portal vein resections increased from 8% (A) to 20% (C; P < 0.01). The overall mortality was 2.4% and comparable in all three periods (2.8%, 2.0%, 2.4%; P = 0.8). Overall complication rates increased from 42% (A) to 56% (C; P < 0.01).
  
  
  CONCLUSIONS
  Mortality remained low despite a more aggressive surgical approach to pancreatic disease. An increased overall morbidity may be explained by more clinically relevant pancreatic fistulas and better documentation.
authors.affiliation: Clinic of General and Visceral Surgery, Department of Surgery, Universitätsklinik Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany. uwe.wittel@uniklinik-freiburg.de.
authors.forename: Uwe A
authors.initials: UA
authors.lastname: Wittel
authors.affiliation: Clinic of General and Visceral Surgery, Department of Surgery, Universitätsklinik Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany. frank.makowiec@uniklinik-freiburg.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Makowiec
authors.affiliation: Clinic of General and Visceral Surgery, Department of Surgery, Universitätsklinik Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany. olivia.sick@uniklinik-freiburg.de.
authors.forename: Olivia
authors.initials: O
authors.lastname: Sick
authors.affiliation: Clinic of General and Visceral Surgery, Department of Surgery, Universitätsklinik Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany. gabriel.seifert@uniklinik-freiburg.de.
authors.forename: Gabriel J
authors.initials: GJ
authors.lastname: Seifert
authors.affiliation: Clinic of General and Visceral Surgery, Department of Surgery, Universitätsklinik Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany. tobias.keck@uksh.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Keck
authors.affiliation: Clinic of General and Visceral Surgery, Department of Surgery, Universitätsklinik Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany. ulrich.adam@vivantes.de.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Adam
authors.affiliation: Clinic of General and Visceral Surgery, Department of Surgery, Universitätsklinik Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany. ulrich.hopt@uniklinik-freiburg.de.
authors.forename: Ulrich T
authors.initials: UT
authors.lastname: Hopt
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D050500:Pancreatitis, Chronic / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult