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Pancreaticoduodenal Resection for Malignancy in a Low-volume Center: Long-term Outcomes from a Developing Country

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Abstract

Background

The technical complexity of pancreatic resection has made it a specialized procedure performed in high-volume centers. It has been shown that patients operated on in high-volume pancreatobiliary centers have fewer complications and better survival. The purpose of this study was to share our experience with and report long-term outcomes of pancreaticoduodenal resections performed in a low-volume center in Pakistan.

Methods

Data of patients who underwent pancreaticoduodenal resection for adenocarcinoma at our institute from 1999 to 2012 were reviewed. A total of 39 patients were included in the study. Variables included patients’ clinical and histopathological characteristics. Outcome was determined based on complication rate, 30- and 90-day mortality, disease-free survival, and overall survival. For survival analysis, Kaplan–Meier curves were used and significance was determined using a log rank test. Univariate Cox analysis was performed to determine significant factors for multivariate analysis.

Results

The majority of tumors [20 (51 %)] were moderate grade, T1/T2 [20 (51 %)], ampullary adenocarcinomas [18 (46 %)]. Mean hospital stay was 14 ± 8 days. The mean number of nodes removed was 13.9 ± 6.9, while mean number of positive nodes was 1 ± 1.7. Expected 5-year overall survival and relapse-free survival were 38 and 48 %, respectively. Overall 5-year survival was significantly different with respect to nodal involvement, i.e., 47 vs. 28 % (P = 0.018). On univariate analysis, nodal involvement was the only factor associated with an increased risk of death (P = 0.02, hazard ratio [HR] 2.9, confidence interval [CI] 1.1–7.8).

Conclusion

Low-volume centers are an acceptable alternate to high-volume centers for performing pancreaticoduodenal resection in carefully selected patients. Efforts should be directed at developing specialized hepatobiliary centers in developing countries.

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Conflicts of interest

The authors have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan

    Abu Bakar Hafeez Bhatti & Aamir Ali Syed

  2. Department of Gastroenterology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan

    Mohammad Aasim Yusuf

  3. Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan

    Syed Ather Saeed Kazmi

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  1. Abu Bakar Hafeez Bhatti
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  2. Mohammad Aasim Yusuf
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  3. Syed Ather Saeed Kazmi
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  4. Aamir Ali Syed
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Correspondence to Abu Bakar Hafeez Bhatti.

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Bhatti, A.B.H., Yusuf, M.A., Kazmi, S.A.S. et al. Pancreaticoduodenal Resection for Malignancy in a Low-volume Center: Long-term Outcomes from a Developing Country. World J Surg 38, 2506–2513 (2014). https://doi.org/10.1007/s00268-014-2644-6

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  • DOI: https://doi.org/10.1007/s00268-014-2644-6

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