Morbidity and mortality after 1028 cephalic duodenopancreatectomies

Abstract

Background: in recent decades the indications for pancreaticoduodenectomy (PD) has been extended. However, series of patients with more than 1000 PD come from a few center in the USA and Europe and none from Latin America.
Objective: to evaluate the morbidity and mortality of 1028 consecutive PD performed by the same surgical team.
Material and methods: we analyzed data from a prospective data base of 1028 consecutive PD. The demographic data, the indication of surgery, the time interval between the onset of symptoms and the first consultation, the classification of the ASA, the type of surgical technique, operative time, placement of biliary drainage, the anatomopathological diagnosis, the morbidity and the mortality was determined. We compared the morbidity and mortality of the PD at two different health centers 
Results: the 1028 PD were performed in a period between July 1994 and December 2014. The mean age was 59.6 years and 565 (55%) were male. The most frequent indications were pancreatic tumor (n = 262) and ampullary tumor (n = 249). Malignant tumors were found in 670 patients. The average time between onset of symptoms and the first consultation was 71 days (range 10-123 days). Preoperative biliary drainage were performed in 461 (44%) patients. Morbility was 35.3% (399 patients). Pancreatic fistula (21%) and delayed gastric emptying (11%) were the most frequent complications. All PD were performed at two centers, one public (n = 642) and the other private (n = 386). Patients operated at the private center had significantly