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Hospital and surgeon volume are potential factors influencing postoperative mortality and morbidity after pancreatic resection. Data on perioperative outcomes of individual surgeons in different institutions, however, are scarce. We evaluated the postoperative outcome after pancreatic head resections (PHR) performed by a high-volume pancreatic surgeon in a high volume university department and (later) in a community hospital (with almost no prior institutional experience with pancreatic surgery).
Methods: We compared the results after PHR personally performed by a single surgeon between 2001 and 10/2006 in a specialized unit of a German University hospital (n=86; DeptA) with the results after PHR performed in a Community hospital between 11/2006 and 2012 (n=135; DeptB). Before the study period (-2001) the surgeon already had a personal caseload of > 200 PHR. In addition to the 221 PHR analyzed here the surgeon also had teached further > 150 PHR to residents and consulting surgeons. The same surgical and perioperative techniques were applied in both series (e.g. abdominal drains, early enteral feeding, pancreaticojejunostomy or pancreaticogastrostomy in PPPD) with the exception of the use of pancreatic duct drains in some patients in DeptB). The data of both series were prospectively recorded in SPSS-databases.
Results: The median age of the patients was lower in DeptA (59 years vs. 67 years in DeptB; p<0.001). Indications for PHR (DeptA n=86 / DeptB n=135) were pancreatic/periampullary cancer (58%/55%), chronic pancreatitis (31%/28%) and various others (11%/17%). Most PHR were PPPD (62%/74%) but the percentage of duodenum-preserving PHR decreased in DeptB (26% vs 14%). Vein resections were performed in 17%/21% (n.s.). Mortality rate was 3.5% in DeptA and 3.7% in DeptB (n.s.). Any complication occurred in 48%/55% (p=0.25). Pancreatic leak (any grade) was present in 26%/24% (n.s.) but grade C leaks were more frequent in DeptA (8% vs 3% in DeptB; p<0.05). Using the expanded Accordion classification complications grade 3 or higher were documented in 14% (DeptA) or 16% (DeptB; n.s.).
Conclusions: Surgeon volume and a high individual experience, respectively, contribute to low mortality and acceptable complication rates after pancreatic head resection. This personal experience may allow for favorable postoperative outcomes after PHR even in a program with almost no prior experience with pancreatic resections.