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257 PANCREATICODUODENECTOMY: PRELIMINARY RESULTS OF A TERTIARY CARE CENTER EXPERIENCE/OUTCOMES JK Law1, P Kazemi2, R Manji2, A Hassanali2, L Sowsa2, CH Scudamore3, AK Buczkowski3, R Enns1 In the 70 years since the first described pancreaticoduodenectomy performed for pancreatic cancer, the Whipple procedure has undergone several refinements in conjunction with the introduction of new technology and perioperative management that has made the surgery justified in the context of decreased mortality and morbidity. The aim of this study is to review all Whipple procedures performed at a single high-volume, tertiary care center between 2001 and 2006. The primary objective was to determine predictors of survival in the setting of primary adenocarcinoma of the head of the pancreas.
1Division of Gastroenterology, Department of Medicine, 2Faculty of Medicine, 3Department of Surgery, University of British Columbia, Vancouver, British Columbia
METHODS: All patients undergoing Whipple surgery at Vancouver General Hospital were reviewed retrospectively. A database on patient demographics, co-morbid status, performance status, associated risk factors for pancreatic cancer, presenting chief complaint, radiological investigations and interventions, diagnostic surgery, operative procedures and technical aspects, postoperative course and pathology were recorded.
RESULTS: 96 patients (51 men, 53.1%) of over 400 have been reviewed to date. The average age at the time of surgery was 63.6 years-old (± 10.8 years). 41 patients (42.7%) were given an ASA III score while 76 patients (79.2%) were felt to be an ECOG0 at the time of presentation. 44 patients (45.8%) presented with jaundice with 30 patients (31.3%) had a chief complaint of abdominal pain. 47 patients (49%) had a preoperative ultrasound and 79 patients (82.3%) had a preoperative CT scan. Of the 96 patients, 83 (86.5%) underwent a preoperative ERCP and 34 patients (35.4%) had diagnostic laparotomy or laparoscopy. 34 patients (35.4%) underwent a traditional Whipple procedure, 49 patients (51.0%) underwent a pylorus-preserving pancreaticoduodenectomy (PPPD) with 92.7% of surgeries had the intent of being a curative procedure. 78 patients (81.3%) were discharged home while 4 patients (4.2%) died in hospital.
CONCLUSIONS: In the context of improved imaging and perioperative management of patients with suspected pancreatic cancer, the increased survival and decreased morbidity associated with a pancreaticoduodenectomy is considered curative in a select group of patients. Further evaluation of our patients will determine if predictors of survival are present to enhance selection.