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Noteworthy Short Term Surgical Outcomes Following Pancreatic Resection by Well Trained Surgeon at a Low-Volume Institution

Sung Geun Kim, Kwang Yeol Paik

Introduction The relationship between hospital procedure volume and surgical outcomes has been a topic of considerable interest. Pancreatic resections are complex and associated with a high risk of complications. Hospitals with a higher volume of pancreatic resections have been shown to have better post-operative outcomes than lower-volume hospitals. However, pancreatic resections previously reserved for severe complication has evolved into a common and safe procedure performed by many surgeons today. This study aimed to investigate outcome of pancreatic resections in low volume center through short term surgical results. Methods 59 patients with pancreatic resections were enrolled during a 3-year periods. Clinically relavent complications were defined as Clavien- Dindo grade III-V complications. Pancreatic fistula and post-pancreatectomy hemorrhage were scored and graded according to standard international consensus definitions. Clinically significant PF was defined grade B or C. The main outcome measures in this study were rates of CR-POPF, clinically significant complications, 90-day mortality, 90-day readmission and reoperation. Results There was 29 pancreaticoduodenectomy, 22 Left sided pancreatectomy, 6 total pancreatectomy, and 2 central pancreatectomy. There was one in hospital mortality (1.67%). Overall CR-POPF rate was 6.6% (n=4), PPH rate was 8.3% (n=5) and CR-complication rate was 13.3% (n=8). 8 patients (13.3%) were hospitalized again after index discharge and 2 patients (3.3%) had to get surgery again. There were no significant differences in CR-complication rates (20.7% vs. 4.5%, vs. 16.7% p=0.37), CR-POPF (10.3% vs. 4.5% vs. 0% p=0.68), or reoperation rates (6.9% vs. 0% vs. 0% p=0.54) among pancreaticoduodenectomy, left sided pancreatectomy and TP groups, respectively. CR-complication was associated with more CR-POPF (p=0.0001). Conclusion Pancreatic resections can be achieved at a low-volume hospital with good results, but longer and more observation will be needed for acceptable.