Forty-Year Experience with the Pancreatoduodenectomy

ABSTRACT

PURPOSE: We reviewed our experience of 700 pancreatoduodenectomies for 40 years to study the clinical characteristics and to find out any changing patterns according to the periods. METHODS: From the first pancreatoduodenectomy in 1961, 700 consecutive pancreatoduodenectomies have been performed in Seoul National University Hospital until August 1999. Annual number of cases, indications, resectability, complications, and survival were analyzed base on three periods (period I '72-'84; period II '85-'90; period III '91-'99). RESULTS: We had got 5 cases or less per year until 1980; thereafter, the number of case increased reaching 70 cases per year recently. Since pylorus-preserving pancreato duodenectomy (PPPD) was introduced in 1990, the proportion of PPPD increased to 60% in 1998. Indications for a pancreatoduodenectomy were periampullary cancer in 85% of the case and other benign or malignant lesions in 15%. The overall resectability was 37% (ampullary 86%; bile duct 42%; duodenal 28%; pancreas; 18%), and there has been an increasing tendency of resectability in pancreatic and bile duct cancer. Overall morbidity rate was 37%, which has been decreasing, however, pancreatic leakage is still an unresolved problem. The overall mortality was 4.7% and improved from 9.1% in period I to 2.5% in period III. There has been a remarkable improvement in the 5-year survival rate for ampullary cancer (period I 31%; II 54%; III 65%) and for bile duct cancer (19%, 32%, 36%), whereas that for pancreatic cancer is still detrimental (7%, 14%, 16%). CONCLUSION: Pancreatoduodenectomy has been increasing probably due to increased incidence of the indications and aggressive resection. Morbidity and mortality have decreased remarkably, and survival has improved, especially for ampullary and bile duct cancer. Therefore, the role of pancreatoduodenectomy for the management of periampullary cancer has become more significant.