Opinion Review
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2022; 10(22): 7620-7630
Published online Aug 6, 2022. doi: 10.12998/wjcc.v10.i22.7620
Whipple’s operation with a modified centralization concept: A model in low-volume Caribbean centers
Shamir O Cawich, Neil W Pearce, Vijay Naraynsingh, Parul Shukla, Rahul R Deshpande
Shamir O Cawich, Vijay Naraynsingh, Department of Clinical Surgical Sciences, University of the West Indies, St Augustine 000000, Trinidad and Tobago
Neil W Pearce, University Surgical Unit, Southampton General Hospital, Southampton SO16 6YD, United Kingdom
Parul Shukla, Department of Surgery, Weill Cornell Medical College, New York, NY 10065, United States
Rahul R Deshpande, Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
Author contributions: Cawich SO, Naraynsingh V, Deshpande R and Shukla P designed and coordinated the study; Pearce NW, Deshpande R, Shukla and Naraynsingh V acquired and analyzed data; Cawich SO, Naraynsingh V, Deshpande R and Shukla P and Pearce NW interpreted the data; Cawich SO, Naraynsingh V, Deshpande R and Shukla P and Pearce NW wrote the manuscript; all authors approved the final version of the article.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shamir O Cawich, FRCS, Full Professor, Department of Clinical Surgical Sciences, University of the West Indies, St Augustine Campus, St Augustine 000000, Trinidad and Tobago. socawich@hotmail.com
Received: December 11, 2021
Peer-review started: December 11, 2021
First decision: April 16, 2022
Revised: May 5, 2022
Accepted: June 26, 2022
Article in press: June 26, 2022
Published online: August 6, 2022
Processing time: 222 Days and 15.9 Hours
Abstract

Conventional data suggest that complex operations, such as a pancreaticoduodenectomy (PD), should be limited to high volume centers. However, this is not practical in small, resource-poor countries in the Caribbean. In these settings, patients have no option but to have their PDs performed locally at low volumes, occasionally by general surgeons. In this paper, we review the evolution of the concept of the high-volume center and discuss the feasibility of applying this concept to low and middle-income nations. Specifically, we discuss a modification of this concept that may be considered when incorporating PD into low-volume and resource-poor countries, such as those in the Caribbean. This paper has two parts. First, we performed a literature review evaluating studies published on outcomes after PD in high volume centers. The data in the Caribbean is then examined and we discuss the incorporation of this operation into resource-poor hospitals with modifications of the centralization concept. In the authors’ opinions, most patients who require PD in the Caribbean do not have realistic opportunities to have surgery in high-volume centers in developed countries. In these settings, their only options are to have their operations in the resource-poor, low-volume settings in the Caribbean. However, post-operative outcomes may be improved, despite low-volumes, if a modified centralization concept is encouraged.

Keywords: Pancreas; Surgery; Pancreatectomy; Whipple’s; Pancreaticoduodenectomy

Core Tip: The published data generally support pancreaticoduodenectomies (PD) being reserved for high volume hospitals. However, this is not practical in resource-poor, low volume countries in the Caribbean. Nevertheless, we have documented good short-term outcomes after PD in this setting. In this paper we discuss a modified centralization concept used to incorporate PD into these low volume centers.