Impact of expanding indications on surgical and oncological outcome in 1434 consecutive pancreatoduodenectomies

Stijn van Roessel, Tara M. Mackay, Johanna A. M. G. Tol, Otto M. van Delden, Krijn P. van Lienden, Chung Y. Nio, Saffire S. K. S. Phoa, Paul Fockens, Jeanin E. van Hooft, Joanne Verheij, Johanna W. Wilmink, Thomas M. van Gulik, Dirk J. Gouma, Olivier R. Busch, Marc G. Besselink

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Abstract

Background: Over the years, high-volume pancreatic centers expanded their indications for pancreatoduodenectomy (PD) but with unknown impact on surgical and oncological outcome. Methods: All consecutive PDs performed between 1992–2017 in a single pancreatic center were identified from a prospectively maintained database and analyzed according to three time periods. Results: In total, 1434 patients underwent PD. Over time, more elderly patients underwent PD (P < 0.001) with increased use of vascular resection (10.4 to 16.0%, P < 0.001). In patients with cancer (n = 1049, 74.8%), the proportion pT3/T4 tumors increased from 54.3% to 70.6% over time (P < 0.001). The postoperative pancreatic fistula (16.0%), postpancreatectomy hemorrhage (8.0%) and delayed gastric emptying (31.0%) rate did not reduce over time, whereas median length of stay decreased from 16 to 12 days (P < 0.001). The overall failure-to-rescue rate (6.9%) and in-hospital mortality (2.2%) remained stable (P = 0.89 and P = 0.45). In 523 patients with pancreatic cancer (36.5%), the use of both adjuvant and neoadjuvant chemotherapy increased over time (both p<0.001), and the five-year overall survival improved from 11.0% to 17.4% (P < 0.001). Conclusions: In a period where indications for PD expanded, with more elderly patients, more advanced cancers and increased use of vascular resections, surgical outcome remained favorable and five-year survival for pancreatic cancer improved.
Original languageEnglish
Pages (from-to)865-875
JournalHPB
Volume21
Issue number7
DOIs
Publication statusPublished - 1 Jul 2019
Externally publishedYes

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