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Erschienen in: World Journal of Surgery 6/2014

01.06.2014

Pancreaticoduodenectomy: Outcomes in a Low-Volume, Specialised Hepato Pancreato Biliary Unit

verfasst von: H. A. Kanhere, M. I. Trochsler, M. H. Kanhere, A. N. Lord, G. J. Maddern

Erschienen in: World Journal of Surgery | Ausgabe 6/2014

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Abstract

Background

This study was designed to evaluate the outcomes of pancreaticoduodenectomy (PD) at a low-volume specialised Hepato Pancreato Biliary (HPB) unit. Volume outcome analyses show significantly better results for patients undergoing PD at high-volume centres (Begg et al. JAMA 280:1747–1751, 1998; Finlayson et al. Arch Surg 138:721–725, 2003; Birkmeyer et al. N Engl J Med 346:1128–1137, 2002; Gouma et al. Ann Surg 232:786–795, 2000). Centralisation of PD seems to be the logical conclusion to be drawn from these results. In countries like Australia with a small and widely dispersed population, centralisation may not be always feasible. Alternative strategy would be to have similar systems in place to those in high-volume centres to achieve similar results at low-volume centres. Many Australian tertiary care centres perform low to medium volumes of PD (Chen et al. HPB 12:101–108, 2010; Kwok et al. ANZ J Surg 80:605–608, 2010; Barnett and Collier ANZ J Surg 76:563–568, 2006; Samra et al. Hepatobiliary Pancreat Dis Int 10:415–421, 2011). Most of these have a specialised HPB unit, accredited by the Australia and New Zealand Hepatic pancreatic and biliary association (ANZHPBA), as training units for post fellowship training in HPB surgery. It is imperative to perform outcome-based analyses in these units to ensure safety and high quality of care.

Methods

Retrospective analysis of database for periampullary carcinoma (1998 till date) was performed in an ANZHPBA accredited HPB unit based at a tertiary care teaching hospital in South Australia. Because age older than 74 years is shown to be a predictive marker of increased morbidity and mortality after a PD, we analysed the outcomes in this subset of patients separately.

Results

Fifty-three patients underwent PD in 14 years. Overall mortality was 3.8 %. The last in hospital mortality was in 1999. The morbidity rates and the oncologic outcomes were similar to those in high-volume units.

Conclusions

PD can be safely performed in a low-volume specialised unit at centres where the amenities and processes at high-volume centres can be replicated.
Literatur
1.
Zurück zum Zitat Begg CB, Cramer LD, Hoskins WJ, Brennan MF (1998) Impact of hospital volume on operative mortality for major cancer surgery. JAMA 280(20):1747–1751PubMedCrossRef Begg CB, Cramer LD, Hoskins WJ, Brennan MF (1998) Impact of hospital volume on operative mortality for major cancer surgery. JAMA 280(20):1747–1751PubMedCrossRef
3.
Zurück zum Zitat Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346(15):1128–1137. doi:10.1056/NEJMsa012337 PubMedCrossRef Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346(15):1128–1137. doi:10.​1056/​NEJMsa012337 PubMedCrossRef
4.
Zurück zum Zitat Gouma DJ, van Geenen RC, van Gulik TM, de Haan RJ, de Wit LT, Busch OR, Obertop H (2000) Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg 232(6):786–795PubMedCentralPubMedCrossRef Gouma DJ, van Geenen RC, van Gulik TM, de Haan RJ, de Wit LT, Busch OR, Obertop H (2000) Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg 232(6):786–795PubMedCentralPubMedCrossRef
5.
Zurück zum Zitat Chen JW, Bhandari M, Astill DS, Wilson TG, Kow L, Brooke-Smith M, Toouli J, Padbury RT (2010) Predicting patient survival after pancreaticoduodenectomy for malignancy: histopathological criteria based on perineural infiltration and lymphovascular invasion. HPB (Oxford) 12(2):101–108. doi:10.1111/j.1477-2574.2009.00140.x CrossRef Chen JW, Bhandari M, Astill DS, Wilson TG, Kow L, Brooke-Smith M, Toouli J, Padbury RT (2010) Predicting patient survival after pancreaticoduodenectomy for malignancy: histopathological criteria based on perineural infiltration and lymphovascular invasion. HPB (Oxford) 12(2):101–108. doi:10.​1111/​j.​1477-2574.​2009.​00140.​x CrossRef
7.
8.
Zurück zum Zitat Samra JS, Bachmann RA, Choi J, Gill A, Neale M, Puttaswamy V, Bell C, Norton I, Cho S, Blome S, Maher R, Gananadha S, Hugh TJ (2011) One hundred and seventy-eight consecutive pancreatoduodenectomies without mortality: role of the multidisciplinary approach. Hepatobiliary Pancreat Dis Int 10(4):415–421PubMedCrossRef Samra JS, Bachmann RA, Choi J, Gill A, Neale M, Puttaswamy V, Bell C, Norton I, Cho S, Blome S, Maher R, Gananadha S, Hugh TJ (2011) One hundred and seventy-eight consecutive pancreatoduodenectomies without mortality: role of the multidisciplinary approach. Hepatobiliary Pancreat Dis Int 10(4):415–421PubMedCrossRef
9.
Zurück zum Zitat Topal B, Van de Sande S, Fieuws S, Penninckx F (2007) Effect of centralization of pancreaticoduodenectomy on nationwide hospital mortality and length of stay. Br J Surg 94(11):1377–1381. doi:10.1002/bjs.5861 PubMedCrossRef Topal B, Van de Sande S, Fieuws S, Penninckx F (2007) Effect of centralization of pancreaticoduodenectomy on nationwide hospital mortality and length of stay. Br J Surg 94(11):1377–1381. doi:10.​1002/​bjs.​5861 PubMedCrossRef
10.
Zurück zum Zitat de Wilde RF, Besselink MG, van der Tweel I, de Hingh IH, van Eijck CH, Dejong CH, Porte RJ, Gouma DJ, Busch OR, Molenaar IQ, Dutch Pancreatic Cancer Group (2012) Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality. Br J Surg 99(3):404–410. doi:10.1002/bjs.8664 PubMedCrossRef de Wilde RF, Besselink MG, van der Tweel I, de Hingh IH, van Eijck CH, Dejong CH, Porte RJ, Gouma DJ, Busch OR, Molenaar IQ, Dutch Pancreatic Cancer Group (2012) Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality. Br J Surg 99(3):404–410. doi:10.​1002/​bjs.​8664 PubMedCrossRef
13.
Zurück zum Zitat Trochsler MTST, Kanhere HA (2011) Pancreatic surgery. In: Wichmann M, Caron N, Maddern G (eds) Rural surgery. Springer, Berlin, pp 187–194CrossRef Trochsler MTST, Kanhere HA (2011) Pancreatic surgery. In: Wichmann M, Caron N, Maddern G (eds) Rural surgery. Springer, Berlin, pp 187–194CrossRef
14.
Zurück zum Zitat Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula Definition (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13. doi:10.1016/j.surg.2005.05.001 PubMedCrossRef Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula Definition (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13. doi:10.​1016/​j.​surg.​2005.​05.​001 PubMedCrossRef
15.
Zurück zum Zitat Lieberman MD, Kilburn H, Lindsey M, Brennan MF (1995) Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg 222(5):638–645PubMedCentralPubMedCrossRef Lieberman MD, Kilburn H, Lindsey M, Brennan MF (1995) Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg 222(5):638–645PubMedCentralPubMedCrossRef
16.
Zurück zum Zitat Welfare A (2006) World population prospects: the 2006 Revision Welfare A (2006) World population prospects: the 2006 Revision
19.
Zurück zum Zitat Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, Sauter PK, Hruban RH, Riall TS, Schulick RD, Choti MA, Lillemoe KD, Yeo CJ (2006) 1423 Pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg 10(9):1199–1210. doi:10.1016/j.gassur.2006.08.018 PubMedCrossRef Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, Sauter PK, Hruban RH, Riall TS, Schulick RD, Choti MA, Lillemoe KD, Yeo CJ (2006) 1423 Pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg 10(9):1199–1210. doi:10.​1016/​j.​gassur.​2006.​08.​018 PubMedCrossRef
20.
Zurück zum Zitat Schmidt CM, Powell ES, Yiannoutsos CT, Howard TJ, Wiebke EA, Wiesenauer CA, Baumgardner JA, Cummings OW, Jacobson LE, Broadie TA, Canal DF, Goulet RJ Jr, Curie EA, Cardenes H, Watkins JM, Loehrer PJ, Lillemoe KD, Madura JA (2004) Pancreaticoduodenectomy: a 20-year experience in 516 patients. Arch Surg 139(7):718–725. doi:10.1001/archsurg.139.7.718 PubMedCrossRef Schmidt CM, Powell ES, Yiannoutsos CT, Howard TJ, Wiebke EA, Wiesenauer CA, Baumgardner JA, Cummings OW, Jacobson LE, Broadie TA, Canal DF, Goulet RJ Jr, Curie EA, Cardenes H, Watkins JM, Loehrer PJ, Lillemoe KD, Madura JA (2004) Pancreaticoduodenectomy: a 20-year experience in 516 patients. Arch Surg 139(7):718–725. doi:10.​1001/​archsurg.​139.​7.​718 PubMedCrossRef
21.
Zurück zum Zitat Teh SH, Diggs BS, Deveney CW, Sheppard BC (2009) Patient and hospital characteristics on the variance of perioperative outcomes for pancreatic resection in the United States: a plea for outcome-based and not volume-based referral guidelines. Arch Surg 144(8):713–721. doi:10.1001/archsurg.2009.67 PubMedCrossRef Teh SH, Diggs BS, Deveney CW, Sheppard BC (2009) Patient and hospital characteristics on the variance of perioperative outcomes for pancreatic resection in the United States: a plea for outcome-based and not volume-based referral guidelines. Arch Surg 144(8):713–721. doi:10.​1001/​archsurg.​2009.​67 PubMedCrossRef
23.
Zurück zum Zitat Sohn TA, Yeo CJ, Cameron JL, Geschwind JF, Mitchell SE, Venbrux AC, Lillemoe KD (2003) Pancreaticoduodenectomy: role of interventional radiologists in managing patients and complications. J Gastrointest Surg 7(2):209–219PubMedCrossRef Sohn TA, Yeo CJ, Cameron JL, Geschwind JF, Mitchell SE, Venbrux AC, Lillemoe KD (2003) Pancreaticoduodenectomy: role of interventional radiologists in managing patients and complications. J Gastrointest Surg 7(2):209–219PubMedCrossRef
24.
Zurück zum Zitat Milstein A, Galvin RS, Delbanco SF, Salber P, Buck CR Jr (2000) Improving the safety of health care: the leapfrog initiative. Eff Clin Pract 3(6):313–316PubMed Milstein A, Galvin RS, Delbanco SF, Salber P, Buck CR Jr (2000) Improving the safety of health care: the leapfrog initiative. Eff Clin Pract 3(6):313–316PubMed
25.
Zurück zum Zitat Sohn TA, Yeo CJ, Cameron JL, Lillemoe KD, Talamini MA, Hruban RH, Sauter PK, Coleman J, Ord SE, Grochow LB, Abrams RA, Pitt HA (1998) Should pancreaticoduodenectomy be performed in octogenarians? J Gastrointest Surg 2(3):207–216PubMedCrossRef Sohn TA, Yeo CJ, Cameron JL, Lillemoe KD, Talamini MA, Hruban RH, Sauter PK, Coleman J, Ord SE, Grochow LB, Abrams RA, Pitt HA (1998) Should pancreaticoduodenectomy be performed in octogenarians? J Gastrointest Surg 2(3):207–216PubMedCrossRef
26.
Zurück zum Zitat Prashant S, Jonathan T, Mauricio S, James S, Peter D (2012) Advanced age is a risk factor for postoperative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review. HPB (Oxford) 14(10):649–657. doi:10.1111/j.1477-2574.2012.00506.x CrossRef Prashant S, Jonathan T, Mauricio S, James S, Peter D (2012) Advanced age is a risk factor for postoperative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review. HPB (Oxford) 14(10):649–657. doi:10.​1111/​j.​1477-2574.​2012.​00506.​x CrossRef
29.
Zurück zum Zitat Yeo CJ, Cameron JL, Sohn TA, Coleman J, Sauter PK, Hruban RH, Pitt HA, Lillemoe KD (1999) Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome. Ann Surg 229(5):613–622 discussion 622-624PubMedCentralPubMedCrossRef Yeo CJ, Cameron JL, Sohn TA, Coleman J, Sauter PK, Hruban RH, Pitt HA, Lillemoe KD (1999) Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome. Ann Surg 229(5):613–622 discussion 622-624PubMedCentralPubMedCrossRef
30.
Zurück zum Zitat La Torre M, Nigri G, Ferrari L, Cosenza G, Ravaioli M, Ramacciato G (2012) Hospital volume, margin status, and long-term survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am Surg 78(2):225–229PubMed La Torre M, Nigri G, Ferrari L, Cosenza G, Ravaioli M, Ramacciato G (2012) Hospital volume, margin status, and long-term survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am Surg 78(2):225–229PubMed
34.
Zurück zum Zitat Michalski CW, Kleeff J, Wente MN, Diener MK, Buchler MW, Friess H (2007) Systematic review and meta-analysis of standard and extended lymphadenectomy in pancreaticoduodenectomy for pancreatic cancer. Br J Surg 94(3):265–273. doi:10.1002/bjs.5716 PubMedCrossRef Michalski CW, Kleeff J, Wente MN, Diener MK, Buchler MW, Friess H (2007) Systematic review and meta-analysis of standard and extended lymphadenectomy in pancreaticoduodenectomy for pancreatic cancer. Br J Surg 94(3):265–273. doi:10.​1002/​bjs.​5716 PubMedCrossRef
Metadaten
Titel
Pancreaticoduodenectomy: Outcomes in a Low-Volume, Specialised Hepato Pancreato Biliary Unit
verfasst von
H. A. Kanhere
M. I. Trochsler
M. H. Kanhere
A. N. Lord
G. J. Maddern
Publikationsdatum
01.06.2014
Verlag
Springer US
Erschienen in
World Journal of Surgery / Ausgabe 6/2014
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-013-2431-9

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