Back to Annual Meeting Posters

Low mortality rates after pancreatic resection (PaRes) have been reported by many centers. Hospital volume, surgeon volume and adequate management of complications are factors contributing to a better outcome. The aim of our study was to evaluate trends in indications, operative techniques and postoperative outcome in more than 1100 PaRes performed in our institution since 1994.
Methods: 1120 PaRes were performed since 1994. The vast majority of the operations was performed by three surgeons. The perioperative data were documented in a pancreatic database. For our analyses the study period was subclassified into three periods (A 1994-2001/n=363; B 2001-2006/n=305; C since 2007/n=452).
Results: 81% of the PaRes were personally performed by one of the 3 principal surgeons. The average annual number of PaRes increased from 52 (period A) to 80 (C; n=107 in 2011). The median age increased from 51 (A) to 65 years (C; p<0.001). In the entire group (n=1120) indications for surgery were pancreatic/periampullary cancer (49%), chronic pancreatitis (CP; 33%) and various other lesions (18%). The percentage of PaRes for CP decreased from over 50% in period A to 17% (C; p<0.01). In contrast the frequency of IPMNs increased from below 1% (A) to 8% (C; p<0.05). About two thirds of the operations were pancreaticoduodenectomies (most PPPD). Due to the lower numbers of operations for CP the rates of duodenum-preserving resections decreased from 18% (A) to 4% (C; p<0.05). A more aggressive approach in some patients with cancer and more resected IPMNs led to an increase in total pancreatectomies during the study period from 1% (A) to 6% (C). The frequency of mesenterico-portal vein resections increased from 8% (A) to 20% (C; p<0.01). Distal resections were performed in 17%. Laparoscopic pancreatic head and distal resections were introduced by one surgeon in period C and were performed in 4.7% of all cases (12% of the cases in period C). Overall mortality was 2.4% and comparable in the 3 periods (2.8%, 2.0%, 2.4%; p=0.8). The 3 principal surgeons in our series also had comparable mortality rates (1.9-3.4%; p=0.41). Overall complication rates increased from 42% (A) to 56% (C; p<0.01). The rate of pancreatic leak grade B/C also increased from 5% (A) to 12% (C; p<0.01) but the frequencies of relaparotomies were comparable (10-14%; n.s.)
Conclusions: Operative mortality in our high-volume institutional series of more than 1100 pancreatic resections was low throughout the study period. Mortality remained low despite a more aggressive surgical approach to (malignant) pancreatic disease (more extended resections, more vein resections, older patients). An increased overall morbidity may be explained by more clinically relevant pancreatic fistulas (more patients with soft pancreas) and better documentation (many patients in randomized studies after period A).