Trends and outcomes of pancreaticoduodenectomy for periampullary tumors: A 25-year single-center study of 1000 consecutive cases.

Autor:	El Nakeeb A; Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt. elnakeebayman@man.edu.eg., Askar W; Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt., Atef E; Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt., Hanafy EE; Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt., Sultan AM; Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt., Salah T; Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt., Shehta A; Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt., Sorogy ME; Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt., Hamdy E; Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt., Hemly ME; Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt., El-Geidi AA; Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt., Kandil T; Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt., Shobari ME; Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt., Allah TA; Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt., Fouad A; Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt., Zeid MA; Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt., Eneen AAE; Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt., El-Hak NG; Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt., Ebidy GE; Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt., Fathy O; Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt., Sultan A; Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt., Wahab MA; Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt.
Jazyk:	angličtina
Zdroj:	World journal of gastroenterology [World J Gastroenterol] 2017 Oct 14; Vol. 23 (38), pp. 7025-7036.
DOI:	10.3748/wjg.v23.i38.7025
Abstrakt:	Aim: To evaluate the evolution, trends in surgical approaches and reconstruction techniques, and important lessons learned from performing 1000 consecutive pancreaticoduodenectomies (PDs) for periampullary tumors. Methods: This is a retrospective review of the data of all patients who underwent PD for periampullary tumor during the period from January 1993 to April 2017. The data were categorized into three periods, including early period (1993-2002), middle period (2003-2012), and late period (2013-2017). Results: The frequency showed PD was increasingly performed after the year 2000. With time, elderly, cirrhotic and obese patients, as well as patients with uncinate process carcinoma and borderline tumor were increasingly selected for PD. The median operative time and postoperative hospital stay decreased significantly over the periods. Hospital mortality declined significantly, from 6.6% to 3.1%. Postoperative complications significantly decreased, from 40% to 27.9%. There was significant decrease in postoperative pancreatic fistula in the second 10 years, from 15% to 12.7%. There was a significant improvement in median survival and overall survival among the periods. Conclusion: Surgical results of PD significantly improved, with mortality rate nearly reaching 3%. Pancreatic reconstruction following PD is still debatable. The survival rate was also improved but the rate of recurrence is still high, at 36.9%. Competing Interests: Conflict-of-interest statement: All authors declare no conflict of interest.
Databáze:	MEDLINE
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