BACKGROUND: It has previously been suggested that high hospital mortality after pancreatic resections is associated with low annual resection rate, but in high volume centers mortality rate is very low. We evaluated the situation in Finland and tried to find out reasons that lead to death and how they depended on the experience of the hospital and surgeon and to find out the actual five-year survival in patients operated due to a malignant disease.
METHODS: In Finland there were performed 374 resections of the pancreatic head 1.1.1990-31.12.1994. The patients' history was evaluated and the cause of death was determined in those died until 31.5.2000.
RESULTS: The history of 350 patients was obtained for analysis. Operations were performed in 33 hospitals and there were 90 surgeons as main operators. According to annual operation volume hospitals were divided to three groups (< 5, 5-10, >10 operations per year). Hospital mortality was 36/350 (10 %) and it decreased considerably as annual volume increased (13 % vs. 7.5 % vs. 3.6 %, p=0.08). Considering the main cause of death, the distribution was: leakages 14 (39 %), abscesses/peritonitis + MOF 7 (20 %), hepatic or intestinal necrosis 5 (14 %), intra abdominal haemorrhage 4 (11 %), cardiac or cerebral insults 4 (11 %), gastrointestinal bleeding 1 (3 %) and other reasons 1 (3 %). The total amount of complications came down in accordance of the annual volume, but there was no statistical difference between single complications. Postoperative hospital care was shorter in hospitals where >10 operations were performed per year in comparison with others; median 18 (8-58) vs. 23 (3-100), p=0.005. It was also shorter after pylorus-preserving resections compared to classic Whipple's resections; median 20 (4-67) vs. 24 (3-100), p=0.05. Of 90 surgeons 3 were main operators in over 20 operations, 7 in 10-19 operations and the rest of them (80) in approximately 2.8 operations. As the surgeons' experience grew up the amount of reoperations decreased (22 % vs. 21 % vs. 6 %; p=0.02) as also did intra abdominal bleeding (7 % vs. 3 % vs. 2 %; p=0.1). There was no significant difference in other complications. In malignant diseases actual five-year survival was in ductal pancreatic adenocarcinoma 21/167 (13 %), in cancer of ampulla of Vater 25/82 (31 %) and in cancer of the main bile duct 4/12 (33 %). Nor was there any significant difference between hospitals when actual survival in different malignant diseases was considered.
CONCLUSIONS: Experience of surgeons and hospitals decreases mortality caused of early complications.