Two Hundred and Fifty-Four Consecutive Pancreaticoduodenectomies without Mortality

Moon, Hyoun Jong; Chang, Weon Young; Heo, Jin Seok; Sohn, Tae Sung; Noh, Jae Hyung; Kim, Sung Joo; Choi, Seong Ho; Joh, Jae Won; Kim, Yong Il

Abstract

PURPOSE: From the early 1990s, operative mortality following pancreaticoduodenectomy have been decreased markedly. And severity of the postoperative complications also has been improved. Experienced hands in large volume hospitals and advances in supportive care have been considered as main reasons. Under this currency, indications for pancreaticoduodenectomy have been expanded, and extended pancreaticoduodenectomy has been tried more occasionally.
METHODS
For 254 consecutive patients who underwent pancreaticoduodenectomy between Dec. 1998 and Mar. 2002, a retrospective analysis of operative mortality and postoperative complications was performed by reviewing of the medical records.
RESULTS
Eighty-five patients were treated for common bile duct cancer, 58 patients for pancreatic cancer, 60 patients for ampulla of Vater cancer, 9 patients for duodenal cancer, 5 patients for advanced gastric cancer, 2 patient for gallbladder cancer, one patient for colon cancer and 34 patients for benign diseases or traumatic conditions. Standard pancreaticoduodecnectomies were performed in 169 patients, pylorus-preserving pancreaticoduodenectomies in 64 patients, total pancreatectomies in 15 patients and hepatopancreaticoduodenectomies in 6 patients. There was no postoperative 30-day or hospital mortality. Postoperative complications were occurred in 100 (39%) patients. The leading complication of this study is hemorrhage in 27 cases (11%) followed by pancreatic fistula in 17 cases (7%), delayed gastric emptying 16 cases (6%) and intraabdominal abscess in 11 cases (4%). There were no significant difference of the incidence of the complications between malignant diseases and benign, above 70-years old and below. Among them in 15 patients (15%) re-operative treatments were needed and in the remain conservative treatments were chosen.
CONCLUSION
Operative mortality itself is no more limited factor for pancreaticoduodenectomy. Most of the complications following pancreaticoduodenectomy can be treated successfully and pancreaticoduodenectomy can be chosen as a safe and effective procedure not only in periampullary tumors but other benign diseases and even old age with same complication risk. But hemorrhagic complication and pancreatic fistula have been remained as serious problems on performing of pancreaticoduodenectomy.