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| Pancreaticoduodenectomy in the Middle East: Achieving optimal results through specialization and standardization |
| Walid Faraj a , ∗, Hussein Nassar a , Ahmad Zaghal a , Deborah Mukherji b , Ali Shamseddine b , Mariam Kanso a , Rola F. Jaafar a , Mohamad Khalife a |
a Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
b Department of Oncology, American University of Beirut Medical Center, Beirut, Lebanon
∗ Corresponding author .
E-mail address: wf07@aub.edu.lb (W. Faraj). |
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Abstract Background: Pancreaticoduodenectomy is a challenging surgical intervention that remains the corner- stone in the treatment of localized peri–ampullary pathologies. The concept of treatment standardization has been well-established in many high-volume centers in the world. Here, we present our experience in pancreaticoduodenectomy from 1994 to 2015.
Methods: We performed a retrospective review of the medical charts of patients who underwent pan- creaticoduodenectomy at our institution. Data was entered to SPSS statistical software and analyzed. The Mann–Whitney U and Fisher’s exact tests were used to report statistical differences between groups.
Results: Of the 370 patients who underwent pacreaticoduodenectomy, 300 were analyzed. The 1-, 3-, 5- and 10-year survival rates were 85%, 35%, 15%, and 7%, respectively with a 30-day mortality rate of 5.0% (15 patients). The median age of the patients was 61 (13–84) years, with 193 (64.3%) males and 107 (35.7%) females. The median operative time was 300 (130–570) min. The median postoperative length of hospital stay was 12 (5–76) days. Thirty-two patients required re-laparotomies; 10 for pancreatic leak, 7 for biliary leak and 15 for control of bleeding. Seventy-five (25.0%) patients developed pancreatic fistulae. Delayed gastric emptying was present in 31 (10.3%) patients. A significant improvement in surgical out- come was observed in cases done after 2008 which indicates the important role of specialized team in surgical management.
Conclusions: The number of patients undergoing pancreaticoduodenectomy has been increasing annu- ally over the past twenty-two years in our institution with results comparable to published series from high-volume centers. Through standardization of surgical techniques and perioperative management car- ried out by a specialist team, our results continue to improve despite the increasing complexity of cases referred to our unit.
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Jin LM, Zhang YH, Zhang CW, Wu WD, Wu J, Dou CW, Wei FQ, Wang ZF, Hu ZM, Zheng SS. Is laparoscopic radical cholecystectomy an effective and safe approach for advanced gallbladder cancer?[J]. Hepatobiliary Pancreat Dis Int, 2020, 19(3): 203-204. |
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2019, Vol. 18 
