Pancreaticoduodenectomy

A 20-year experience in 516 patients

C. Schmidt, Emilie S. Powell, Constantin Yiannoutsos, Thomas Howard, Eric A. Wiebke, Chad A. Wiesenauer, Joel A. Baumgardner, Oscar Cummings, Lewis E. Jacobson, Thomas A. Broadie, David F. Canal, Robert J. Goulet, Eardie A. Curie, Higinia Cardenes, John M. Watkins, Patrick Loehrer, Keith D. Lillemoe, James A. Madura, Gerard V. Aranha, William W. Turner & 6 others Thomas A. Stellato, Richard A. Prinz, Sachinder Hans, Arthur J. Donovan, Michael B. Farnell, Fabrizio Michelassi

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Abstract

Hypothesis: Pancreaticoduodenectomy (PD) is a safe procedure for a variety of periampullary conditions. Design: Retrospective review of a prospectively collected database. Setting: Academic tertiary care hospital. Patients: A total of 516 consecutive patients who underwent PD. Main Outcome Measures: Patient outcomes and survival factors. Results: Pathological examination demonstrated 57% periampullary cancers, 22% chronic pancreatitis, 12% cystic neoplasms, 4% islet cell neoplasms, and 5% other. Fifty-one percent of patients underwent pylorus preservation. Median operating time was 5 hours; blood loss, 1300 mL; and transfusion requirement, 1.5 U. Postoperative complications occurred in 43% of patients, including cardiopulmonary events (15%), fistula (9%), delayed gastric emptying (7%), and sepsis (6%). Additional surgery was required in 3% of patients, most commonly because of bleeding. Perioperative mortality was 3.9% overall but only 1.8% in patients with chronic pancreatitis; 25% of patients who died had preoperative complications associated with their periampullary condition. Three-year survival was 15% after resection for pancreatic cancer, 42% for duodenal cancer, 53% for ampullary cancer, and 62% for bile duct cancer. Univariate predictors of long-term survival in patients with periampullary adenocarcinoma included elevated glucose levels, liver function test results, abnormal tumor markers, blood loss, transfusion requirement, type of operation, and pathologic findings (periampullary adenocarcinoma type, differentiation, and margin and node status). Multivariate predictors were serum total bilirubin level, blood loss, operation type, diagnosis, and lymph node status. Conclusions: Pancreaticoduodenectomy continues to be associated with considerable morbidity. With careful patient selection, PD can be performed safely. Long-term survival in patients with periampullary adenocarcinoma can be predicted by preoperative laboratory values, intraoperative factors, and pathologic findings.

Original languageEnglish
Pages (from-to)718-727
Number of pages10
JournalArchives of Surgery
Volume139
Issue number7
DOIs
StatePublished - Jul 2004

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Pancreaticoduodenectomy
Bile Duct Neoplasms
Adenocarcinoma
Survival
Chronic Pancreatitis
Duodenal Neoplasms
Neoplasms
Gastric Emptying
Liver Function Tests
Pylorus
Tertiary Healthcare
Tumor Biomarkers
Pancreatic Neoplasms
Islets of Langerhans
Bilirubin
Tertiary Care Centers
Blood Transfusion
Patient Selection
Fistula
Sepsis

ASJC Scopus subject areas

  • Surgery

Cite this

Pancreaticoduodenectomy : A 20-year experience in 516 patients. / Schmidt, C.; Powell, Emilie S.; Yiannoutsos, Constantin; Howard, Thomas; Wiebke, Eric A.; Wiesenauer, Chad A.; Baumgardner, Joel A.; Cummings, Oscar; Jacobson, Lewis E.; Broadie, Thomas A.; Canal, David F.; Goulet, Robert J.; Curie, Eardie A.; Cardenes, Higinia; Watkins, John M.; Loehrer, Patrick; Lillemoe, Keith D.; Madura, James A.; Aranha, Gerard V.; Turner, William W.; Stellato, Thomas A.; Prinz, Richard A.; Hans, Sachinder; Donovan, Arthur J.; Farnell, Michael B.; Michelassi, Fabrizio.

In: Archives of Surgery, Vol. 139, No. 7, 07.2004, p. 718-727.

Research output: Contribution to journalArticle

Schmidt, C, Powell, ES, Yiannoutsos, C, Howard, T, Wiebke, EA, Wiesenauer, CA, Baumgardner, JA, Cummings, O, Jacobson, LE, Broadie, TA, Canal, DF, Goulet, RJ, Curie, EA, Cardenes, H, Watkins, JM, Loehrer, P, Lillemoe, KD, Madura, JA, Aranha, GV, Turner, WW, Stellato, TA, Prinz, RA, Hans, S, Donovan, AJ, Farnell, MB & Michelassi, F 2004, 'Pancreaticoduodenectomy: A 20-year experience in 516 patients', Archives of Surgery, vol. 139, no. 7, pp. 718-727. https://doi.org/10.1001/archsurg.139.7.718
Schmidt, C. ; Powell, Emilie S. ; Yiannoutsos, Constantin ; Howard, Thomas ; Wiebke, Eric A. ; Wiesenauer, Chad A. ; Baumgardner, Joel A. ; Cummings, Oscar ; Jacobson, Lewis E. ; Broadie, Thomas A. ; Canal, David F. ; Goulet, Robert J. ; Curie, Eardie A. ; Cardenes, Higinia ; Watkins, John M. ; Loehrer, Patrick ; Lillemoe, Keith D. ; Madura, James A. ; Aranha, Gerard V. ; Turner, William W. ; Stellato, Thomas A. ; Prinz, Richard A. ; Hans, Sachinder ; Donovan, Arthur J. ; Farnell, Michael B. ; Michelassi, Fabrizio. / Pancreaticoduodenectomy : A 20-year experience in 516 patients. In: Archives of Surgery. 2004 ; Vol. 139, No. 7. pp. 718-727.
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T2 - A 20-year experience in 516 patients

AU - Schmidt, C.

AU - Powell, Emilie S.

AU - Yiannoutsos, Constantin

AU - Howard, Thomas

AU - Wiebke, Eric A.

AU - Wiesenauer, Chad A.

AU - Baumgardner, Joel A.

AU - Cummings, Oscar

AU - Jacobson, Lewis E.

AU - Broadie, Thomas A.

AU - Canal, David F.

AU - Goulet, Robert J.

AU - Curie, Eardie A.

AU - Cardenes, Higinia

AU - Watkins, John M.

AU - Loehrer, Patrick

AU - Lillemoe, Keith D.

AU - Madura, James A.

AU - Aranha, Gerard V.

AU - Turner, William W.

AU - Stellato, Thomas A.

AU - Prinz, Richard A.

AU - Hans, Sachinder

AU - Donovan, Arthur J.

AU - Farnell, Michael B.

AU - Michelassi, Fabrizio

PY - 2004/7

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N2 - Hypothesis: Pancreaticoduodenectomy (PD) is a safe procedure for a variety of periampullary conditions. Design: Retrospective review of a prospectively collected database. Setting: Academic tertiary care hospital. Patients: A total of 516 consecutive patients who underwent PD. Main Outcome Measures: Patient outcomes and survival factors. Results: Pathological examination demonstrated 57% periampullary cancers, 22% chronic pancreatitis, 12% cystic neoplasms, 4% islet cell neoplasms, and 5% other. Fifty-one percent of patients underwent pylorus preservation. Median operating time was 5 hours; blood loss, 1300 mL; and transfusion requirement, 1.5 U. Postoperative complications occurred in 43% of patients, including cardiopulmonary events (15%), fistula (9%), delayed gastric emptying (7%), and sepsis (6%). Additional surgery was required in 3% of patients, most commonly because of bleeding. Perioperative mortality was 3.9% overall but only 1.8% in patients with chronic pancreatitis; 25% of patients who died had preoperative complications associated with their periampullary condition. Three-year survival was 15% after resection for pancreatic cancer, 42% for duodenal cancer, 53% for ampullary cancer, and 62% for bile duct cancer. Univariate predictors of long-term survival in patients with periampullary adenocarcinoma included elevated glucose levels, liver function test results, abnormal tumor markers, blood loss, transfusion requirement, type of operation, and pathologic findings (periampullary adenocarcinoma type, differentiation, and margin and node status). Multivariate predictors were serum total bilirubin level, blood loss, operation type, diagnosis, and lymph node status. Conclusions: Pancreaticoduodenectomy continues to be associated with considerable morbidity. With careful patient selection, PD can be performed safely. Long-term survival in patients with periampullary adenocarcinoma can be predicted by preoperative laboratory values, intraoperative factors, and pathologic findings.

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