Continuing fast-track (Expedited) pancreaticoduodenectomy service during the COVID-19 pandemic: Experience from an established pancreatic surgical centre

ABSTRACT

Aim: Avoiding preoperative Biliary drainage (PBD) can facilitate early curative Surgery for patients with periampullary tumours. However, The evidence over PBD is conflicting. This prospective re-audit aimed to assess compliance to NICE guidelines (NG85) and surgical outcomes at a well-established HpB Surgery unit after achieving additional theatre sessions following prior audit. Method(s) Prospective data collection and analysis for all patients undergoing pancreaticoduodenectomy with curative intent was performed as re-audit at a tertiary pancreatic centre between September 2020 to August 2021. Result(s) 64 or 71 patients received curative pancreaticoduodenectomy (43 Kausch-Whipple & 23 pylorus-preserving pancreaticoduodenectomy, 7 inoperable). of 29 patients without PBD, 10 were jaundiced with median bilirubin levels of 138 Micromole/L (range 27-357 Mmol/L). Median time (range) from diagnostic imaging to Surgery with curative intent was 21 days (3-42) for patients without PBD compared to 62 days (22-305) for those with PBD (p=0.00028). No statistically significant difference in median HDU/ITU stay (4 Vs 3 days, p=0.849), postoperative complications (C-D>2) (30% Vs 27.8%, p=0.755), RO resection rates (42.8% Vs 75%, p=0.364), and median hospital stay (17 Vs 10 days, p=0.076) was observed for patients without or with PBD respectively. Interestingly, inoperable patients had shorter time delay from diagnostic imaging to Surgery (29 Vs 49 days, p=0.010) Conclusion(s) Fast-track (expedited) pancreaticoduodenectomy is feasible and safe for selected group of jaundiced patients without PBD. The constraints and challenges posed by COVID-19 pandemic are likely reflected in higher number of patients receiving PBD (42/71) despite clear referral pathway established following prior work at our institute.