Original articleImplementation of a regional reference center in pancreatic surgery. Experience after 631 proceduresImplementación de un centro de referencia regional en cirugía pancreática. Experiencia tras 631 procedimientos☆
Graphical abstract
Introduction
Although postoperative mortality is currently around 5% in high-volume pancreatic surgery (PS) centers1, 2, morbidity continues to be high, reaching rates up to 60%3, 4. Regardless of the general surgical complications associated with any procedure, PS presents specific complications: delayed gastric emptying (DGE), pancreatic fistula (PF) and post-pancreatectomy hemorrhage (PPH), with associated incidences of 19%–7%5, 2%–20%6 and 1%–8%7, respectively.
Sabater et al.8 established the required quality standards for oncological PS, proposing rates of resectability >58%, morbidity <73% and mortality <10%, with associated rates of biliary fistula (BF) <14%, PF< 29%, PPH< 21% and reoperation <20%, with a mean stay <21 days.
The three most common types of PS are pancreaticoduodenectomy (PD), distal pancreatectomy (DP), and total pancreatectomy (TP). The postoperative morbidity rate associated with PD is 50%–60%, with a mortality rate of 5%9; TP associates a morbidity of 59.3% and mortality 2.1%10; DP is the group with the lowest morbidity and mortality rates, at 18% and 0.6%11, respectively.
The main objective of this study is to determine whether the Hepato-Biliary-Pancreatic Surgery and Liver Transplantation Unit of the Hospital Universitario de Badajoz meets the quality standards required by the medical community for PS reference centers in terms of perioperative results. The secondary objectives are to compare the different PS techniques performed in terms of early postoperative morbidity and mortality rates and to analyze the impact of extended resections in these terms.
Section snippets
Methods
We have conducted a descriptive, retrospective, single-center study from 2006 to 2019. The study included all patients who underwent surgery for pancreatic pathology, either malignant or benign, by our unit, which is a regional pancreatic surgery referral center. Emergency surgery was excluded.
Results
In the study period, 631 PS were performed, with an associated resectability rate of 80.2%. The most frequent PS was PD, followed by DP and TP (Table 1).
The three groups are homogeneous in terms of epidemiological and preoperative variables, except for patient sex (P = .007) and the rates of PBD (P = .03) and neoadjuvant therapy (P = .001), both of which were higher in the PD group (Table 1). Surgical salvage rates after neoadjuvant treatment were 100% in the DP group and 42.2% in the PD group (
Discussion
In 1999, Birkmeyer et al. reported post-PD mortality rates with the volumes of surgery at hospital centers, suggesting that the centralization of pancreatic surgery could impact patient survival31. Two years later, in 2001, the Institute of Medicine (IM) defined the concept of quality in the medical field, which is comprised of six elements: safety, effectiveness, timeliness, efficiency, centralization and equity32. Subsequently, in 2004, the Leapfrog group, with the aim to improve quality,
Conflict of interests
The authors have no conflict of interests to declare.
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Please cite this article as: Castillo Tuñón JM, Valle Rodas ME, Botello Martínez F, Rojas Holguín A, López Guerra D, Santos Naharro J, et al. Implementación de un centro de referencia regional en cirugía pancreática. Experiencia tras 631 procedimientos. Cir Esp. 2021;99:745–756.