One thousand consecutive pancreaticoduodenectomies
One thousand consecutive pancreaticoduodenectomies
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DOI：
10.1097/01.sla.0000217673.04165.ea
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发表时间：
2006-07-01
影响因子：
9
通讯作者：
Belcher, KA
中科院分区：
文献类型：
--
作者：
Cameron, JL;Riall, TS;Belcher, KA
目的：追溯胰腺切除术的发展，从20世纪60年代的十年到新千年的第一个十年，通过一个外科医生做1000个连续operations.Summary背景资料的经验：区域切除术的头部胰腺首次成功地进行了Kausch在1909年。1935年维普莱报道了3例胰管切除术，推广了该手术。由于住院死亡率约为25%，直到20世纪80年代，手术才很少进行。从20世纪80年代开始，这种复杂的消化道手术的经验增加，并开发了高容量中心。这导致了在医院死亡率显着下降，并允许机构和个人获得大experiences.Methods：1969年3月至2003年5月，1000个连续的pancreaticoectomies由一个单一的外科医生进行。一个前瞻性维护的数据库进行回顾性审查，以确定这些患者的管理和结果，以及文件的演变，这种手术过程超过5decades.Results：中位手术时间显着下降，在几十年来，在20世纪70年代和5.5小时，在2000年。术后住院时间从20世纪80年代的中位数17天下降到21世纪初的9天。只有10例术后/住院死亡，死亡率为1%。共405例患者因胰头腺癌接受了胰管切除术。总的5年生存率为18%;淋巴结阴性患者为32%;淋巴结阴性、边缘阴性患者为41%。手术时间、失血量和住院时间大幅下降。手术安全，住院死亡率低。它已成为一种有效的手术治疗胰腺癌的病人在他们的肿瘤是边缘阴性和淋巴结阴性。
Objective: To trace the evolution of pancreaticoduodenectomy from the decade of the 1960s through the first decade of the new Millenium, through the experience of one surgeon doing 1000 consecutive operations.Summary Background Data: A regional resection of the head of the pancreas was first performed successfully by Kausch in 1909. The operation was popularized by Whipple in 1935, who reported 3 pancreaticoduodenectomies. Because of a hospital mortality of approximately 25%, the operation was performed infrequently until the 1980s. From the 1980s on, experience with this complex alimentary tract operation increased, and high-volume centers developed. This resulted in a significant drop in hospital mortality and allowed institutions and individuals to gain large experiences.Methods: Between March 1969 and May 2003, 1000 consecutive pancreaticoduodenectomies were performed by a single surgeon. A retrospective review of a prospectively maintained database was performed to determine the management and outcome of these patients, as well as to document the evolution of this operative procedure over 5 decades.Results: The median operative time decreased significantly over the decades, being 8.8 hours in the 1970s and 5.5 hours during the 2000s. Postoperative length of stay dropped from a median of 17 days in the 1980s to 9 days in the 2000s. There were only 10 postoperative/hospital deaths, for a mortality of 1%. A total of 405 patients underwent pancreaticoduodenectomy for adenocarcinoma of the head of the pancreas. Overall 5-year survival was 18%; for the lymph node-negative patients, it was 32%; and for node-negative, margin-negative patients, it was 41%.Conclusions: Pancreaticoduodenectomy has become a commonly performed operation in many tertiary care centers. Operative time, blood loss, and length of stay have dropped substantially. The operation has become safe, with a low hospital mortality. It has become an effective operation for pancreatic cancer in those patients in whom their tumor is margin negative and node negative.