J Med Assoc Thai 2008; 91 (7):1043

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Seven Years Experience of Pancreaticoduodenectomy at Sawanpracharak Hospital
Wipassakornwarawut S Mail

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.

Keywords:
Pancreaticoduodenectomy

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