Two Thousand Consecutive Pancreaticoduodenectomies

The first successful local resection of a periampullary tumor was performed by Halsted in 1898. Kausch performed the first regional resection in 1909, and the operation was popularized by Whipple in 1935. The operation was infrequently performed until the 1980s and 1990s. STUDY DESIGN: Two thousand consecutive pancreaticoduodenectomies performed by 1 surgeon (JLC) from the 1960s to the 2000s were retrospectively reviewed from a prospectively maintained database. The first 1,000 were performed over a period of 34 years, the second 1,000 over a period of 9 years.

The most common indication throughout was adenocarcinoma of the head of the pancreas (PDAC, 46%). Benign intraductal papillary mutinous neoplasm (IPMN) increased from 1% (1990s) to 8% (2000s) (p = 0.002). Age range was 13 years to 103 years. Mean age increased from 59 years (1980s) to 66 (2000s) (p = 0.001), as did those older than 80 (3% to 12%, p = 0.002). Thirty-day mortality was 1.4%; hospital mortality was 1.7%. Delayed gastric emptying (23%), pancreatic fistulas (16%), and wound infections (11%), were the most frequent morbidity, and have not decreased. The median number of blood transfusions decreased from 2 (1980s) to 0 (1990s and 2000s) (p = 0.004). Length of stay decreased from 21 days (1980s) to 13 (1990s) days to 10 days (2000s) (p = 0.002). Five-year survival for PDAC increased from 19% (1990s) to 24% (2000s) (p = 0.02), and 5-year survival for node-negative, margin-negative PDAC patients was 39%.