Trends and outcomes of pancreaticoduodenectomy for periampullary tumors: A 25-year single-center study of 1000 consecutive cases

To evaluate the evolution, trends in surgical approaches and reconstruction techniques, and important lessons learned from performing 1000 consecutive pancreaticoduodenectomies (PDs) for periampullary tumors. This is a retrospective review of the data of all patients who underwent PD for periampulla...

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Published in:	World journal of gastroenterology : WJG Vol. 23; no. 38; pp. 7025 - 7036
Main Authors:	El Nakeeb, Ayman, Askar, Waleed, Atef, Ehab, Hanafy, Ehab El, Sultan, Ahmad M, Salah, Tarek, Shehta, Ahmed, Sorogy, Mohamed El, Hamdy, Emad, Hemly, Mohamed El, El-Geidi, Ahmed A, Kandil, Tharwat, Shobari, Mohamed El, Allah, Talaat Abd, Fouad, Amgad, Zeid, Mostafa Abu, Eneen, Ahmed Abu El, El-Hak, Nabil Gad, Ebidy, Gamal El, Fathy, Omar, Sultan, Ahmed, Wahab, Mohamed Abdel
Format:	Journal Article
Language:	English
Published:	United States Baishideng Publishing Group Inc 14-10-2017
Subjects:	Retrospective Study Postoperative pancreatic fistula Pancreaticoduodenectomy Pancreaticojejunostomy Pancreaticogastrostomy Periampullary tumor
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Summary:	To evaluate the evolution, trends in surgical approaches and reconstruction techniques, and important lessons learned from performing 1000 consecutive pancreaticoduodenectomies (PDs) for periampullary tumors. This is a retrospective review of the data of all patients who underwent PD for periampullary tumor during the period from January 1993 to April 2017. The data were categorized into three periods, including early period (1993-2002), middle period (2003-2012), and late period (2013-2017). The frequency showed PD was increasingly performed after the year 2000. With time, elderly, cirrhotic and obese patients, as well as patients with uncinate process carcinoma and borderline tumor were increasingly selected for PD. The median operative time and postoperative hospital stay decreased significantly over the periods. Hospital mortality declined significantly, from 6.6% to 3.1%. Postoperative complications significantly decreased, from 40% to 27.9%. There was significant decrease in postoperative pancreatic fistula in the second 10 years, from 15% to 12.7%. There was a significant improvement in median survival and overall survival among the periods. Surgical results of PD significantly improved, with mortality rate nearly reaching 3%. Pancreatic reconstruction following PD is still debatable. The survival rate was also improved but the rate of recurrence is still high, at 36.9%.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Telephone: +2-50-6752021 Author contributions: El Nakeeb A designed the research; El Nakeeb A, Askar W, Atef E, El Hanafy E, Sultan AM, Salah T, Shehta A, El Sorogy M, Hamdy E, El Hemly M, El-Geidi AA, Kandil T, El Shobari M, Allah TA, Fouad A, Zeid MA, El Eneen AA, El-Hak NG, El Ebidy G, Fathy O, Sultan A and Wahab MA performed the research; El Nakeeb A analyzed the data; El Nakeeb A, Shehta A and El Sorogy M wrote the paper. Correspondence to: Ayman El Nakeeb, Professor, Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt. elnakeebayman@man.edu.eg
ISSN:	1007-9327 2219-2840
DOI:	10.3748/wjg.v23.i38.7025