Seven years experience of pancreaticoduodenectomy at Sawanpracharak Hospital.

ABSTRACT

BACKGROUND: Pancreaticoduodenectomy is a major procedure with significant mortality and morbidity. Pancreaticoduodenectomy is a safe procedure for a variety of periampullary conditions at Sawanpracharak Hospital. OBJECTIVE: To evaluate complications, morbidity, and mortality. The effects of clinical and variables related to patient mortality. MATERIAL AND METHOD: Retrospective medical records review of 52 patients who underwent pancreaticoduodenectomy at Sawanpracharak Hospital between February 2000 and November 2006 was conducted. Of these, 12 patients who died after pancreaticoduodenectomy were studied. RESULTS: Of 52 cases, 29 males and 23 females, the median age was 64 years (age range, 32-82 years). Median operative time was 3.70 hours (range, 2.0-9.5 hours). Pathological examination demonstrated 38.46% ampullary cancer 26.92% pancreatic cancer, 1.92% duodenal cancer, 11.54% periampullary cancer, 3.85% gastric cancer, 1.92% gastrointestinal stromal tumor, 5.77% chronic pancreatitis, 1.92% cystadenoma of pancreas, 1.92 chronic gastric ulcer, 1.92% leiomyoma of duodenum, and 3.85% no pathologic report. Fifty percent of patients underwent pylorus preservation pancreaticoduodenectomy. Postoperative complications occurred in 40.38% of patients, including intraabdominal abscess (19.05%), pancreatic fistula (14.29%), bowel fistula (9.52%), internal bleeding (9.52,%), sepsis (9.52%), superior mesenteric occlusion (4.76%), bile fistula (4.76%), cholangitis (4.76%), acute renal failure (14.29%), pneumonia (4.76%), acute myocardial infarction (4.76%), and additional surgery was required in 13.46% of patients. Overall perioperative mortality was 23.08% with only one patient with benign disease (chronic pancreatitis) died postoperatively. Underlying medical disease conditions did not influence postoperative morbidity or mortality. Natures of surgical complications were indicated as causes of significant higher mortality. The median follow-up for patients was 3.37 months (range, 0.5-65.7 months, mean 8.71 +/- 13.66 months). CONCLUSION: Pancreaticoduodenectomy still causes considerable morbidity and mortality. With careful patient selection, preoperative assessment of respectability, surgical technique, critical care anesthesia, and postoperative care, pancreaticoduodenectomy can be performed safely and improve the results to an acceptable level.