TY - JOUR
T1 - Changes in Morbidity after Pancreatic Resection
T2 - Toward the End of Completion Pancreatectomy
AU - Büchler, Markus W.
AU - Wagner, Markus
AU - Schmied, Bruno M.
AU - Uhl, Waldemar
AU - Friess, Helmut
AU - Z'graggen, Kaspar
AU - Fong, Yuman
PY - 2003/12
Y1 - 2003/12
N2 - Hypothesis: Advances in specialized centers for pancreatic diseases have improved surgical morbidity and outcome. In the past, postoperative local complications (pancreatic fistulae) were causing most of the mortality. Now, more patients experience postoperative complications related to their comorbidity. Design: To report a prospective audit of a single center's experience with pancreatic resection during an 8-year period. Setting: Tertiary referral center focused on pancreatic diseases. Patients and Interventions: Six hundred seventeen consecutive patients underwent pancreatectomy between November 1, 1993, and August 31, 2001. The series included 468 pancreatic head resections (76%), 25 total pancreatectomies (4%), 88 left-sided resections (14%), and 36 others (6%). Main Outcome Measures: Morbidity after pancreatic resection. Results: Postoperative in-hospital mortality was 1.6%, and the additional operation rate was 4.1%. Four patients died of surgical complications and 6 of systemic complications. Systemic morbidity was 18% and consisted primarily of cardiopulmonary complications (13%). The most frequent postoperative complication was delayed gastric emptying (14%), which caused significant prolongation of the hospital stay. No patients died of a postoperative pancreatic fistula, which occurred in 3.2%, and no completion pancreatectomies were necessary. Conclusions: Pancreatic resections can be performed with considerable safety and a low rate of pancreatic complications. More patients die of systemic complications than in the past, which increases the demand for precise preoperative patient selection. Completion pancreatectomy should no longer be considered in patients with a pancreatic fistula.
AB - Hypothesis: Advances in specialized centers for pancreatic diseases have improved surgical morbidity and outcome. In the past, postoperative local complications (pancreatic fistulae) were causing most of the mortality. Now, more patients experience postoperative complications related to their comorbidity. Design: To report a prospective audit of a single center's experience with pancreatic resection during an 8-year period. Setting: Tertiary referral center focused on pancreatic diseases. Patients and Interventions: Six hundred seventeen consecutive patients underwent pancreatectomy between November 1, 1993, and August 31, 2001. The series included 468 pancreatic head resections (76%), 25 total pancreatectomies (4%), 88 left-sided resections (14%), and 36 others (6%). Main Outcome Measures: Morbidity after pancreatic resection. Results: Postoperative in-hospital mortality was 1.6%, and the additional operation rate was 4.1%. Four patients died of surgical complications and 6 of systemic complications. Systemic morbidity was 18% and consisted primarily of cardiopulmonary complications (13%). The most frequent postoperative complication was delayed gastric emptying (14%), which caused significant prolongation of the hospital stay. No patients died of a postoperative pancreatic fistula, which occurred in 3.2%, and no completion pancreatectomies were necessary. Conclusions: Pancreatic resections can be performed with considerable safety and a low rate of pancreatic complications. More patients die of systemic complications than in the past, which increases the demand for precise preoperative patient selection. Completion pancreatectomy should no longer be considered in patients with a pancreatic fistula.
UR - http://www.scopus.com/inward/record.url?scp=0345492048&partnerID=8YFLogxK
U2 - 10.1001/archsurg.138.12.1310
DO - 10.1001/archsurg.138.12.1310
M3 - Article
C2 - 14662530
AN - SCOPUS:0345492048
SN - 0004-0010
VL - 138
SP - 1310
EP - 1315
JO - Archives of Surgery
JF - Archives of Surgery
IS - 12
ER -