Published online Oct 14, 2017. doi: 10.3748/wjg.v23.i38.7025
Peer-review started: May 18, 2017
First decision: June22, 2017
Revised: June 28, 2017
Accepted: August 2, 2017
Article in press: August 2, 2017
Published online: October 14, 2017
Processing time: 153 Days and 10.8 Hours
To evaluate the evolution, trends in surgical approaches and reconstruction techniques, and important lessons learned from performing 1000 consecutive pancreaticoduodenectomies (PDs) for periampullary tumors.
This is a retrospective review of the data of all patients who underwent PD for periampullary tumor during the period from January 1993 to April 2017. The data were categorized into three periods, including early period (1993-2002), middle period (2003-2012), and late period (2013-2017).
The frequency showed PD was increasingly performed after the year 2000. With time, elderly, cirrhotic and obese patients, as well as patients with uncinate process carcinoma and borderline tumor were increasingly selected for PD. The median operative time and postoperative hospital stay decreased significantly over the periods. Hospital mortality declined significantly, from 6.6% to 3.1%. Postoperative complications significantly decreased, from 40% to 27.9%. There was significant decrease in postoperative pancreatic fistula in the second 10 years, from 15% to 12.7%. There was a significant improvement in median survival and overall survival among the periods.
Surgical results of PD significantly improved, with mortality rate nearly reaching 3%. Pancreatic reconstruction following PD is still debatable. The survival rate was also improved but the rate of recurrence is still high, at 36.9%.
Core tip: Pancreaticoduodenectomy (PD) is a complex abdominal procedure. The hospital mortality rate has decreased to less than 5%; however, the rate of postoperative morbidities remains high, from 40% to 50%. Pancreatic reconstruction following PD is still debatable. The long survival rate after PD is clearly improved with time but still poor. Frequency showed PD is increasingly performed. With time, elderly, cirrhotic and obese patients, and patients with uncinate process carcinoma and borderline tumor are increasingly selected for PD. Median operative time and postoperative hospital stay decreased significantly. Hospital mortality declined significantly, from 6.6% to 3.1%. Postoperative complications significantly decreased.