Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: Pathology, complications, and outcomes

Charles J. Yeo, John L. Cameron, Taylor A. Sohn, Keith D. Lillemoe, Henry A. Pitt, Mark A. Talamini, Ralph H. Hruban, Sarah E. Ord, Patricia K. Sauter, JoAnn Coleman, Marianna L. Zahurak, Louise B. Grochow, Ross A. Abrams

Research output: Contribution to journalArticle

1586 Citations (Scopus)

Abstract

Objective: The authors reviewed the pathology, complications, and outcomes in a consecutive group of 650 patients undergoing pancreaticoduodenectomy in the 1990s. Summary Background Data: Pancreaticoduodenectomy has been used increasingly in recent years to resect a variety of malignant and benign diseases of the pancreas and periampullary region. Methods: Between January 1990 and July 1996, inclusive, 650 patients underwent pancreaticoduodenal resection at The Johns Hopkins Hospital. Data were recorded prospectively on all patients. All pathology specimens were reviewed and categorized. Statistical analyses were performed using both univariate and multivariate models. Results: The patients had a mean age of 63 ± 12.8 years, with 54% male and 91% white. The number of resections per year rose from 60 in 1990 to 161 in 1995. Pathologic examination results showed pancreatic cancer (n = 282; 43%), ampullary cancer (n = 70; 11%), distal common bile duct cancer (n = 65; 10%), duodenal cancer (n = 26; 4%), chronic pancreatitis (n = 71; 11%), neuroendocrine tumor (n = 31; 5%), periampullary adenoma (n = 21; 3%), cystadenocarcinoma (n = 14; 2%), cystadenoma (n = 25; 4%), and other (n = 45; 7%). The surgical procedure involved pylorus preservation in 82%, partial pancreatectomy in 95%, and portal or superior mesenteric venous resection in 4%. Pancreatic-enteric reconstruction, when appropriate, was via pancreaticojejunostomy in 71% and pancreaticogastrostomy in 29%. The median intraoperative blood loss was 625 mL, median units of red cells transfused was zero, and the median operative time was 7 hours. During this period, 190 consecutive pancreaticoduodenectomies were performed without a mortality. Nine deaths occurred in-hospital or within 30 days of operation (1.4% operative mortality). The postoperative complication rate was 41%, with the most common complications being early delayed gastric emptying (19%), pancreatic fistula (14%), and wound infection (10%). Twenty-three patients required reoperation in the immediate postoperative period (3.5%), most commonly for bleeding, abscess, or dehiscence. The median postoperative length of stay was 13 days. A multivariate analysis of the 443 patients with periampullary adenocarcinoma indicated that the most powerful independent predictors favoring long-term survival included a pathologic diagnosis of duodenal adenocarcinoma, tumor diameter <3 cm, negative resection margins, absence of lymph node metastases, well-differentiated histology, and no reoperation. Conclusions: This single institution, high-volume experience indicates that pancreaticoduodenectomy can be performed safely for a variety of malignant and benign disorders of the pancreas and periampullary region. Overall survival is determined largely by the pathology within the resection specimen.

Original languageEnglish (US)
Pages (from-to)248-260
Number of pages13
JournalAnnals of Surgery
Volume226
Issue number3
DOIs
StatePublished - 1997
Externally publishedYes

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Pancreaticoduodenectomy
Pathology
Reoperation
Pancreas
Adenocarcinoma
Duodenal Neoplasms
Cystadenocarcinoma
Pancreaticojejunostomy
Bile Duct Neoplasms
Cystadenoma
Pancreatic Fistula
Pancreatectomy
Survival
Neuroendocrine Tumors
Mortality
Gastric Emptying
Pylorus
Chronic Pancreatitis
Common Bile Duct
Wound Infection

ASJC Scopus subject areas

  • Surgery

Cite this

Yeo, C. J., Cameron, J. L., Sohn, T. A., Lillemoe, K. D., Pitt, H. A., Talamini, M. A., ... Abrams, R. A. (1997). Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: Pathology, complications, and outcomes. Annals of Surgery, 226(3), 248-260. https://doi.org/10.1097/00000658-199709000-00004

Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s : Pathology, complications, and outcomes. / Yeo, Charles J.; Cameron, John L.; Sohn, Taylor A.; Lillemoe, Keith D.; Pitt, Henry A.; Talamini, Mark A.; Hruban, Ralph H.; Ord, Sarah E.; Sauter, Patricia K.; Coleman, JoAnn; Zahurak, Marianna L.; Grochow, Louise B.; Abrams, Ross A.

In: Annals of Surgery, Vol. 226, No. 3, 1997, p. 248-260.

Research output: Contribution to journalArticle

Yeo, CJ, Cameron, JL, Sohn, TA, Lillemoe, KD, Pitt, HA, Talamini, MA, Hruban, RH, Ord, SE, Sauter, PK, Coleman, J, Zahurak, ML, Grochow, LB & Abrams, RA 1997, 'Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: Pathology, complications, and outcomes', Annals of Surgery, vol. 226, no. 3, pp. 248-260. https://doi.org/10.1097/00000658-199709000-00004
Yeo, Charles J. ; Cameron, John L. ; Sohn, Taylor A. ; Lillemoe, Keith D. ; Pitt, Henry A. ; Talamini, Mark A. ; Hruban, Ralph H. ; Ord, Sarah E. ; Sauter, Patricia K. ; Coleman, JoAnn ; Zahurak, Marianna L. ; Grochow, Louise B. ; Abrams, Ross A. / Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s : Pathology, complications, and outcomes. In: Annals of Surgery. 1997 ; Vol. 226, No. 3. pp. 248-260.
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abstract = "Objective: The authors reviewed the pathology, complications, and outcomes in a consecutive group of 650 patients undergoing pancreaticoduodenectomy in the 1990s. Summary Background Data: Pancreaticoduodenectomy has been used increasingly in recent years to resect a variety of malignant and benign diseases of the pancreas and periampullary region. Methods: Between January 1990 and July 1996, inclusive, 650 patients underwent pancreaticoduodenal resection at The Johns Hopkins Hospital. Data were recorded prospectively on all patients. All pathology specimens were reviewed and categorized. Statistical analyses were performed using both univariate and multivariate models. Results: The patients had a mean age of 63 ± 12.8 years, with 54{\%} male and 91{\%} white. The number of resections per year rose from 60 in 1990 to 161 in 1995. Pathologic examination results showed pancreatic cancer (n = 282; 43{\%}), ampullary cancer (n = 70; 11{\%}), distal common bile duct cancer (n = 65; 10{\%}), duodenal cancer (n = 26; 4{\%}), chronic pancreatitis (n = 71; 11{\%}), neuroendocrine tumor (n = 31; 5{\%}), periampullary adenoma (n = 21; 3{\%}), cystadenocarcinoma (n = 14; 2{\%}), cystadenoma (n = 25; 4{\%}), and other (n = 45; 7{\%}). The surgical procedure involved pylorus preservation in 82{\%}, partial pancreatectomy in 95{\%}, and portal or superior mesenteric venous resection in 4{\%}. Pancreatic-enteric reconstruction, when appropriate, was via pancreaticojejunostomy in 71{\%} and pancreaticogastrostomy in 29{\%}. The median intraoperative blood loss was 625 mL, median units of red cells transfused was zero, and the median operative time was 7 hours. During this period, 190 consecutive pancreaticoduodenectomies were performed without a mortality. Nine deaths occurred in-hospital or within 30 days of operation (1.4{\%} operative mortality). The postoperative complication rate was 41{\%}, with the most common complications being early delayed gastric emptying (19{\%}), pancreatic fistula (14{\%}), and wound infection (10{\%}). Twenty-three patients required reoperation in the immediate postoperative period (3.5{\%}), most commonly for bleeding, abscess, or dehiscence. The median postoperative length of stay was 13 days. A multivariate analysis of the 443 patients with periampullary adenocarcinoma indicated that the most powerful independent predictors favoring long-term survival included a pathologic diagnosis of duodenal adenocarcinoma, tumor diameter <3 cm, negative resection margins, absence of lymph node metastases, well-differentiated histology, and no reoperation. Conclusions: This single institution, high-volume experience indicates that pancreaticoduodenectomy can be performed safely for a variety of malignant and benign disorders of the pancreas and periampullary region. Overall survival is determined largely by the pathology within the resection specimen.",
author = "Yeo, {Charles J.} and Cameron, {John L.} and Sohn, {Taylor A.} and Lillemoe, {Keith D.} and Pitt, {Henry A.} and Talamini, {Mark A.} and Hruban, {Ralph H.} and Ord, {Sarah E.} and Sauter, {Patricia K.} and JoAnn Coleman and Zahurak, {Marianna L.} and Grochow, {Louise B.} and Abrams, {Ross A.}",
year = "1997",
doi = "10.1097/00000658-199709000-00004",
language = "English (US)",
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pages = "248--260",
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T1 - Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s

T2 - Pathology, complications, and outcomes

AU - Yeo, Charles J.

AU - Cameron, John L.

AU - Sohn, Taylor A.

AU - Lillemoe, Keith D.

AU - Pitt, Henry A.

AU - Talamini, Mark A.

AU - Hruban, Ralph H.

AU - Ord, Sarah E.

AU - Sauter, Patricia K.

AU - Coleman, JoAnn

AU - Zahurak, Marianna L.

AU - Grochow, Louise B.

AU - Abrams, Ross A.

PY - 1997

Y1 - 1997

N2 - Objective: The authors reviewed the pathology, complications, and outcomes in a consecutive group of 650 patients undergoing pancreaticoduodenectomy in the 1990s. Summary Background Data: Pancreaticoduodenectomy has been used increasingly in recent years to resect a variety of malignant and benign diseases of the pancreas and periampullary region. Methods: Between January 1990 and July 1996, inclusive, 650 patients underwent pancreaticoduodenal resection at The Johns Hopkins Hospital. Data were recorded prospectively on all patients. All pathology specimens were reviewed and categorized. Statistical analyses were performed using both univariate and multivariate models. Results: The patients had a mean age of 63 ± 12.8 years, with 54% male and 91% white. The number of resections per year rose from 60 in 1990 to 161 in 1995. Pathologic examination results showed pancreatic cancer (n = 282; 43%), ampullary cancer (n = 70; 11%), distal common bile duct cancer (n = 65; 10%), duodenal cancer (n = 26; 4%), chronic pancreatitis (n = 71; 11%), neuroendocrine tumor (n = 31; 5%), periampullary adenoma (n = 21; 3%), cystadenocarcinoma (n = 14; 2%), cystadenoma (n = 25; 4%), and other (n = 45; 7%). The surgical procedure involved pylorus preservation in 82%, partial pancreatectomy in 95%, and portal or superior mesenteric venous resection in 4%. Pancreatic-enteric reconstruction, when appropriate, was via pancreaticojejunostomy in 71% and pancreaticogastrostomy in 29%. The median intraoperative blood loss was 625 mL, median units of red cells transfused was zero, and the median operative time was 7 hours. During this period, 190 consecutive pancreaticoduodenectomies were performed without a mortality. Nine deaths occurred in-hospital or within 30 days of operation (1.4% operative mortality). The postoperative complication rate was 41%, with the most common complications being early delayed gastric emptying (19%), pancreatic fistula (14%), and wound infection (10%). Twenty-three patients required reoperation in the immediate postoperative period (3.5%), most commonly for bleeding, abscess, or dehiscence. The median postoperative length of stay was 13 days. A multivariate analysis of the 443 patients with periampullary adenocarcinoma indicated that the most powerful independent predictors favoring long-term survival included a pathologic diagnosis of duodenal adenocarcinoma, tumor diameter <3 cm, negative resection margins, absence of lymph node metastases, well-differentiated histology, and no reoperation. Conclusions: This single institution, high-volume experience indicates that pancreaticoduodenectomy can be performed safely for a variety of malignant and benign disorders of the pancreas and periampullary region. Overall survival is determined largely by the pathology within the resection specimen.

AB - Objective: The authors reviewed the pathology, complications, and outcomes in a consecutive group of 650 patients undergoing pancreaticoduodenectomy in the 1990s. Summary Background Data: Pancreaticoduodenectomy has been used increasingly in recent years to resect a variety of malignant and benign diseases of the pancreas and periampullary region. Methods: Between January 1990 and July 1996, inclusive, 650 patients underwent pancreaticoduodenal resection at The Johns Hopkins Hospital. Data were recorded prospectively on all patients. All pathology specimens were reviewed and categorized. Statistical analyses were performed using both univariate and multivariate models. Results: The patients had a mean age of 63 ± 12.8 years, with 54% male and 91% white. The number of resections per year rose from 60 in 1990 to 161 in 1995. Pathologic examination results showed pancreatic cancer (n = 282; 43%), ampullary cancer (n = 70; 11%), distal common bile duct cancer (n = 65; 10%), duodenal cancer (n = 26; 4%), chronic pancreatitis (n = 71; 11%), neuroendocrine tumor (n = 31; 5%), periampullary adenoma (n = 21; 3%), cystadenocarcinoma (n = 14; 2%), cystadenoma (n = 25; 4%), and other (n = 45; 7%). The surgical procedure involved pylorus preservation in 82%, partial pancreatectomy in 95%, and portal or superior mesenteric venous resection in 4%. Pancreatic-enteric reconstruction, when appropriate, was via pancreaticojejunostomy in 71% and pancreaticogastrostomy in 29%. The median intraoperative blood loss was 625 mL, median units of red cells transfused was zero, and the median operative time was 7 hours. During this period, 190 consecutive pancreaticoduodenectomies were performed without a mortality. Nine deaths occurred in-hospital or within 30 days of operation (1.4% operative mortality). The postoperative complication rate was 41%, with the most common complications being early delayed gastric emptying (19%), pancreatic fistula (14%), and wound infection (10%). Twenty-three patients required reoperation in the immediate postoperative period (3.5%), most commonly for bleeding, abscess, or dehiscence. The median postoperative length of stay was 13 days. A multivariate analysis of the 443 patients with periampullary adenocarcinoma indicated that the most powerful independent predictors favoring long-term survival included a pathologic diagnosis of duodenal adenocarcinoma, tumor diameter <3 cm, negative resection margins, absence of lymph node metastases, well-differentiated histology, and no reoperation. Conclusions: This single institution, high-volume experience indicates that pancreaticoduodenectomy can be performed safely for a variety of malignant and benign disorders of the pancreas and periampullary region. Overall survival is determined largely by the pathology within the resection specimen.

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