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Introduction: There is an ongoing debate about the feasibility of performing HPB cases in low-volume, community hospitals. We decided to analyze outcomes of HPB surgical cases done in our community teaching hospital and compare it with published data from academic centers and /or national data.
Materials and methods: We reviewed all HPB cases (liver, pancreas, bile duct cases) performed in an eight year period (2001-2009) by an HPB-fellowship trained surgeon (P.F.S.) at our hospital. All electronic files of the patients who underwent HPB surgery were reviewed and all pertinent clinical information was retrieved. 30 days morbidity and mortality were analyzed. All complications were graded according to the Clavien classification. Pancreatic specific complications -pancreatic fistula/leak and delayed gastric emptying were graded using International Study Group on Pancreatic Fistula ( ISGPF) and International Study Group of Pancreatic Surgery ( ISGPS ) definitions.
Results: There were 140 HPB cases performed. These included 33 pancreatoduodenectomies, 29 distal pancreatectomies, 52 hepatic cases and 26 cases of other cases involving the pancreas and biliary tract. Overall complication rate was 36, 4% .Using Clavien classifications, there were 26 Grade 1 complications (60,4 %), 13 Grade 2 complications (30,2%) and 4 Grade 3 complications (9,3%) .2 patients underwent reoperation for postoperative complications. Overall mortality was 0.7% (1 patient). Pancreas-specific complications included 6% pancreatic leak rate after pancreatoduodenectomy and 24.1% leak rate for distal pancreatectomy.
Conclusion: HPB surgery can be safely performed in a community setting, with morbidity and mortality comparable to high-volume centers. Appropriate surgical expertise and clinical resources are necessary to provide satisfactory outcomes.