Lessons Learned from 100 Personal Consecutive Cases of Pancreaticoduodenectomy at a University Hospital in Thailand
Suvit Sriussadaporn MD*, Sukanya Sriussadaporn MD*, Rattaplee Pak-art MD*, Kritaya Kritayakirana MD*, Supparerk Prichayudh MD*, Pasurachate Samorn MD*
Affiliation : * Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Background : Pancreaticoduodenectomy (PD) is a major operation with potential disastrous complications. Experience of
the surgical team with high surgical volume is an important factor contributing to better outcome. The purpose of this study
was to examine results of 100 consecutive cases of PD operated by the first author. Various aspects of this technically
demanding operation related to our experience were discussed and reviewed.
Material and Method: A retrospective study of 100 patients who had undergone PD during a period of 20.5 years was
presented. The indications for PD were periampullary neoplasms or other symptomatic lesions at the pancreatic head. All
patients had preoperative CT scan to evaluate extent of the disease and resectability. Preoperative biliary drainage was
performed in selected cases. The operations were conducted in the same manner in most cases. Before 2000, no external
drainage of the pancreatic remnant was used. Since 2000, external drainage of the pancreatic remnant was routinely used,
except in one patient who had total pancreatectomy. Postoperative complications and mortality were studied.
Results : Carcinoma of the ampulla of Vater and carcinoma of the head of the pancreas were the leading indications for PD
(34% and 30%, respectively). No preoperative tissue diagnosis was made in patients who had carcinoma of the head of the
pancreas. Two patients had emergency PD because of massive gastrointestinal bleeding. Sixty seven per cent underwent
pylorus preserving PD (PPPD) and 33% underwent classical PD. Twenty eight patients had no external pancreatic drainage,
71 had external pancreatic drainage, and one had total pancreatectomy. The postoperative morbidity and mortality were
44% and 2%, respectively. The postoperative pancreatic fistula rate was higher in patients without external pancreatic stent
but no statistical significance was detected (21.4% vs. 12.7%, NS). There was no mortality in patients aged >70 years
(n = 29) while two patients aged <70 died (n = 71). The difference was not statistically significant.
Conclusion : PD could be safely performed with low pancreatic fistula and low mortality rate by experienced surgeons.
Preoperative CT scan is extremely helpful in evaluation the extent of the disease and resectability. In patients with suspected
carcinoma of the pancreatic head, PD should be performed without preoperative tissue diagnosis by experienced pancreatic
surgeons. Elderly (aged >70 years) is not a contraindication for PD. We strongly recommend the use of external pancreatic
stent to prevent pancreatic fistula.
Keywords : Periampullary neoplasm, Carcinoma of the head of the pancreas, Pancreaticoduodenectomy, External pancreatic stent, Pancreatic fistula
