title: Is pancreaticodoudenectomy with vascular resection a safe procedure in developing country? Early outcomes and review of national literature.
abstract: BACKGROUND
  Safety of extended lymphadenectomy (EL) ± vascular resection in patients undergoing pancreaticoduodenectomy (PD) in resource limited settings is not well established. The objective of this study was to report outcomes of PD resection with EL ± vascular resection from Pakistan and review national literature.
  
  
  METHODS
  Data of patients who underwent PD between 2011 and 2014 was reviewed. A total of 66 patients were included in the study. Primary outcome was 90 day morbidity and mortality. Secondary objective was 2 year overall survival.
  
  
  RESULTS
  Median age was 57 (32-82) years. Majority patients had locally advanced (pT3/T4) tumors and nodal involvement i.e. 44 (71%) and 42 (67.8%). Mean number of excised lymph nodes and positive lymph nodes was 28.2 ± 12.8 (range 3-62) and 4.8 ± 6.9 (range 0-27) respectively. There were 13 vascular resections including 3 arterial resections. Overall 90 day morbidity was 31.8% and mortality was 3%. No difference in complication rate was observed in patients who did and did not undergo vascular resection i.e. 18% versus 34.5% (P = 0.1). Similarly, median survival was 11 (3-24) months and 11 (1-36) months and not significantly different (P = 0.5).
  
  
  CONCLUSIONS
  In developing countries, extended lymphadenectomy with vascular resection can be safely performed with pancreaticoduodenectomy in specialized hepatobiliary units.
authors.affiliation: Department of HPB and Liver Transplantation, Shifa International Hospital Islamabad, Pakistan.
authors.forename: Faisal Saud
authors.initials: FS
authors.lastname: Dar
authors.affiliation: Department of HPB and Liver Transplantation, Shifa International Hospital Islamabad, Pakistan. Electronic address: Abubakar.hafeez@yahoo.com.
authors.forename: Abu Bakar Hafeez
authors.initials: AB
authors.lastname: Bhatti
authors.affiliation: Department of HPB and Liver Transplantation, Shifa International Hospital Islamabad, Pakistan.
authors.forename: Abdul Wahab
authors.initials: AW
authors.lastname: Dogar
authors.affiliation: Department of HPB and Liver Transplantation, Shifa International Hospital Islamabad, Pakistan.
authors.forename: Haseeb
authors.initials: H
authors.lastname: Zia
authors.affiliation: Department of HPB and Liver Transplantation, Shifa International Hospital Islamabad, Pakistan.
authors.forename: Ihsan
authors.initials: I
authors.lastname: Ulhaq
authors.affiliation: Department of Radiology, Shifa International Hospital Islamabad, Pakistan.
authors.forename: Atif
authors.initials: A
authors.lastname: Rana
authors.affiliation: Department of Anesthesiology, Shifa International Hospital Islamabad, Pakistan.
authors.forename: Nasir Ayub
authors.initials: NA
authors.lastname: Khan
authors.affiliation: Department of HPB and Liver Transplantation, Shifa International Hospital Islamabad, Pakistan.
authors.forename: Amna
authors.initials: A
authors.lastname: Liaqat
authors.affiliation: Department of Gastroenterology/Hepatology, Shifa International Hospital Islamabad, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Salih
authors.affiliation: Department of Gastroenterology/Hepatology, Shifa International Hospital Islamabad, Pakistan.
authors.forename: Najmul Hassan
authors.initials: NH
authors.lastname: Shah
mesh_terms: D003906:Developing Countries; D006801:Humans; D010154:Pakistan; D010190:Pancreatic Neoplasms / Q000098:blood supply* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: Developing country; Pancreaticoduodenectomy; Survival