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Quarter century experience of pancreatic surgery in a high volume center - a SWOT analysis of 2925 consecutive pancreatic resections

2019; Elsevier BV; Volume: 21; Linguagem: Inglês

10.1016/j.hpb.2019.10.1289

1477-2574

Fritz Klein, Matthäus Felsenstein, Uwe Pelzer, Hanno Riess, Timm Denecke, Johann Pratschke, Marcus Bahra,

Renal cell carcinoma treatment

Background: Pancreatic surgery at high volume centers has undergone major changes over the last decades. However, the quality of surgery remains to be considered as one important factor for achieving long-term survival especially in patients at advanced stages of disease. Methods: Between January 1990 and September 2016 2925 consecutive patients have undergone pancreatic resection at our institution. A SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis of all relevant parameters was performed. Results: A total of 2176 pancreatic head resections (74%), 475 distal pancreatectomies (16%), 190 total pancreatectomies (7%) and 84 other resections (3%) were performed within our study period. Additional vascular resections were performed in 262 patients (9%). 164 patients (6%) underwent additional liver resection. Postoperative morbidity occurred in 750 patients (26%). Perioperative mortality occurred in 88 patients (3%). Overall survival strongly depended on the underlying disease, as well as on lymph node stage (p = < 0.001 ) and surgical radicality (p = <.001). Conclusion: The decentralization of pancreatic surgery over the last decades has led to a focus on high-volume centers for extended procedures in complex patients. Present SWOT analysis underlines the significance of a centralization of pancreatic surgery for patient safety and to increase the chance of even long-term survival.