Integration of effort for secure pancreaticoduodenectomy improved surgical outcomes: Historical observational study

Purpose: To study the impact of strategies focusing attention on the safety of pancreaticoduodenectomy (PD) on postoperative outcome. Methods: Since 2012, tailored pancreaticoenterostomy, modification of stent insertion and organized drain management were applied according to risk for postoperative pancreatic fistula (POPF). Patients who performed PD after 2012 were enrolled into the prospective cohort, named experimental group (EG), and those who performed prior 2012 were enrolled into the historical control cohort (HG). Short term surgical outcomes were analyzed. Results: HG included 90 patients and EG included 85 patients. Overall rate of Clinically relevant (CR)-POPF was 13.7% (24/175), 18.9% in HG (17/90) and 8.2% in EG (7/85), respectively (p=0.049). Postoperative delayed gastric emptying, rate of postoperative bleeding, length of hospital stay, and mortality rate did not show any difference between groups. Postoperative complications of Clavien-Dindo 3 or higher were significantly reduced in the EG (22.2% vs 8.2%, p=0.012). Conclusions: After the application of a new surgical policy and management, CR-POPF rate and high-grade complication rate decreased by more than half.