A team of researchers from Boston, Massachusetts, USA, investigated the outcome of patients undergoing pancreatic resection over a 10-year period.
733 consecutive patients undergoing pancreatic resection for benign or malignant disease between 1990 and 2000 were enrolled in the study.
Of these resections, 489 were pancreaticoduodenectomy (PD); 190 distal pancreatectomy; 40 total pancreatectomy; and 14 middle-segment pancreatectomy.
The researchers measured length of stay; occurrence of complications; and mortality; and they compared patients in 3 periods according to the implementation of case management (July 1995) and clinical pathways (September 1998).
For PD, patients in Group 1 (April 1990 to June 1995) were significantly younger (mean 57 years) than those in Group 2 (July 1995 to August 1998; mean 62 years) and Group 3 (September 1998 to October 2000; mean 65 years).
Over time, the proportion of PD for cystic tumors increased from 9.9% to 20% and the proportion of PD for chronic pancreatitis decreased from 23% to 10%. Use of pylorus-preserving PD decreased from 45% to 0%.
Delayed gastric emptying was found to decrease from 17% to 6%. Pancreatic fistula, reoperation, and mortality were unchanged.
|Mean age of pancreaticoduodenectomy patients:|
1990-1995: 57 years
1995-1998: 62 years
1998-2000: 65 years
|Archives of Surgery|
Mean length of stay for PD decreased from 16.1 to 9.5 days.
Period, case volume, pylorus-preserving PD, and presence of complications were all found to be independent predictors of length of stay.
For distal pancreatectomy, patients in Groups 2 and 3 were older than those in Group 1 (mean 57 vs. 52 years).
Resections for cystic tumors increased from 26% to 52%, and resections for chronic pancreatitis decreased from 32% to 14%.
Median length of stay decreased from 9 days to 6.
For total pancreatectomy, resections for cystic tumors increased from 18% to 43%. Median length of stay decreased from 14.5 days to 11.
The researchers found that for all resections, case volume increased from 4 resections per month in 1990 to 5.8 in 1995, and 12 in 2000.
Dr James Balcom, of the Massachusetts General Hospital, said on behalf of colleagues, "Older patients are increasingly being selected for pancreatic resection. This reflects an increasing frequency of operations performed for cystic tumors and fewer for chronic pancreatitis.
"With the exception of delayed gastric emptying, complications and mortality have remained the same or decreased slightly during the past 10 years."
"However, there has been a significant decrease in length of stay; this is the result of implementation of case management and clinical pathways, increasing case volume, decreasing incidence of delayed gastric emptying, and decreasing use of pylorus-preserving PD," he concluded.