Retrospective Analysis of 101 Consecutive Cases of Pancreaticoduodenectomy in Single Center

Pancreatoduodenectomy has been associated with high rates of complications (4060 %) and mortality (up to 20 %) With improvements in surgical techniques and perioperative care, mortality rates have decreased significantly, with operative mortality rates of less than 5 % in high-volume centers. AIM To analyze the preoperative and perioperative variables, the pattern of morbidity and results of perioperative care in reducing the morbidity, the factors predicting and predisposing to mortality and formulate standard for pancreaticoduodenectomy in terms of patient selection, operative procedures and perioperative care to achieve good outcome. PATIENTS AND METHODS 101 consecutive patients (66 men, 34 women, mean age, years, range 2478 Years) between January 2007April 2010. All data from patients were prospectively collected. the patients included in the list are resectable periampullary lesions, carcinoma head of pancreas, duodenal malignancy, and distal CBD growth, mass lesion in head of pancreas with suspected malignancy after routine clinical and radiological investigations. RESULTSPeriampullary carcinoma is the commonest indication for pancreatico duodenectomy in our center. Preoperative albumin value less than 3.0 WAS associated with complications. CA19-9 level less than120 in majority of our patient and correlates with resectability. Preoperative biliary drainage had associated with infectious complications and increased morbidity. hence role of preop biliary drainage was not found useful in our smaller study. CBD size and type of anastomosis (continuous) forhepatico jejunostomy had no influence in outcome, Hence, continuous end to side HJ preferable as it takes lesser operative time after tedious pancreatic anastomosis. Undilated MPD (less than3mm) and soft pancreas were associated with Increased morbidity, with increased pancreatic leak and hemorrhagic complications. Pancretico jejunostomy had increased leak rate compared to PG in our study, probably related to volume of work with this type of anastomosis. Hence PG is the commonest reconstruction preferable in our institution. Hemorrhagic complications all early complications were saved with early recognition and appropriate management, Stressing the need of vigilant post operative monitoring for this major procedure. DGE is the common post operative complication our study, though not related to mortality it increased the post op hospital stay and also cost of treatment for the patients. Most of the complications were managed conservatively. patient need surgical intervention had fair results. In our small series reported 30 day mortality isless than2 %, but morbidity remains 45-50 %, though this is the area needs attention. CONCLUSIONVolume of the center and skill of surgical team, standard of preoperative care, in addition to the patient selection and optimization determines the outcome of pancreaticduodenectiomy. By adhering to above principles, it will be possible to do pancreaticoduodenectomy without mortality and limited morbidity with normal postoperative stay. Pancreas surgery has been the subject of much scrutiny worldwide, with accumulating evidence assuming that high volume centers provide better results.