Pancreaticoduodenectomy: outcomes in a low-volume, specialised Hepato Pancreato Biliary unit

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dc.contributor.authorKanhere, H.
dc.contributor.authorTrochsler, M.
dc.contributor.authorKanhere, M.
dc.contributor.authorLord, A.
dc.contributor.authorMaddern, G.
dc.date.issued2014
dc.description.abstractBackground This study was designed to evaluate the outcomes of pancreaticoduodenectomy (PD) at a low-volume specialised Hepato Pancreato Biliary (HPB) unit. Volume outcome analyses show significantly better results for patients undergoing PD at high-volume centres (Begg et al. JAMA 280:1747–1751, 1998; Finlayson et al. Arch Surg 138:721–725, 2003; Birkmeyer et al. N Engl J Med 346:1128–1137, 2002; Gouma et al. Ann Surg 232:786–795, 2000). Centralisation of PD seems to be the logical conclusion to be drawn from these results. In countries like Australia with a small and widely dispersed population, centralisation may not be always feasible. Alternative strategy would be to have similar systems in place to those in high-volume centres to achieve similar results at low-volume centres. Many Australian tertiary care centres perform low to medium volumes of PD (Chen et al. HPB 12:101–108, 2010; Kwok et al. ANZ J Surg 80:605–608, 2010; Barnett and Collier ANZ J Surg 76:563–568, 2006; Samra et al. Hepatobiliary Pancreat Dis Int 10:415–421, 2011). Most of these have a specialised HPB unit, accredited by the Australia and New Zealand Hepatic pancreatic and biliary association (ANZHPBA), as training units for post fellowship training in HPB surgery. It is imperative to perform outcome-based analyses in these units to ensure safety and high quality of care. Methods Retrospective analysis of database for periampullary carcinoma (1998 till date) was performed in an ANZHPBA accredited HPB unit based at a tertiary care teaching hospital in South Australia. Because age older than 74 years is shown to be a predictive marker of increased morbidity and mortality after a PD, we analysed the outcomes in this subset of patients separately. Results Fifty-three patients underwent PD in 14 years. Overall mortality was 3.8 %. The last in hospital mortality was in 1999. The morbidity rates and the oncologic outcomes were similar to those in high-volume units. Conclusions PD can be safely performed in a low-volume specialised unit at centres where the amenities and processes at high-volume centres can be replicated.
dc.description.statementofresponsibilityH. A. Kanhere, M. I. Trochsler, M. H. Kanhere, A. N. Lord, G. J. Maddern
dc.identifier.citationWorld Journal of Surgery, 2014; 38(6):1484-1490
dc.identifier.doi10.1007/s00268-013-2431-9
dc.identifier.issn0364-2313
dc.identifier.issn1432-2323
dc.identifier.orcidTrochsler, M. [0000-0001-6961-1430] [0000-0002-0650-9153]
dc.identifier.orcidMaddern, G. [0000-0003-2064-181X]
dc.identifier.urihttp://hdl.handle.net/2440/85181
dc.language.isoen
dc.publisherSpringer
dc.rights© Société Internationale de Chirurgie 2013
dc.source.urihttps://doi.org/10.1007/s00268-013-2431-9
dc.subjectAnimals
dc.subjectHumans
dc.subjectPancreatic Neoplasms
dc.subjectPostoperative Complications
dc.subjectTreatment Outcome
dc.subjectPancreaticoduodenectomy
dc.subjectHospital Mortality
dc.subjectRisk Assessment
dc.subjectRetrospective Studies
dc.subjectCohort Studies
dc.subjectFollow-Up Studies
dc.subjectAge Factors
dc.subjectSex Factors
dc.subjectTime Factors
dc.subjectAged
dc.subjectMiddle Aged
dc.subjectSurgery Department, Hospital
dc.subjectWorkload
dc.subjectAustralia
dc.subjectFemale
dc.subjectMale
dc.titlePancreaticoduodenectomy: outcomes in a low-volume, specialised Hepato Pancreato Biliary unit
dc.typeJournal article
pubs.publication-statusPublished

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