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One Thousand Consecutive Pancreaticoduodenectomies

Published on Jul 1, 2006in Annals of Surgery9.476
· DOI :10.1097/01.sla.0000217673.04165.ea
John L. Cameron118
Estimated H-index: 118
(Johns Hopkins University),
Taylor S. Riall35
Estimated H-index: 35
(Johns Hopkins University)
+ 1 AuthorsKenneth A. Belcher1
Estimated H-index: 1
(Johns Hopkins University)
Abstract
The first successful local resection of a periampullary tumor was performed by Dr. William Stewart Halsted in 1898.1 The patient was a 58-year-old woman with obstructive jaundice. Halsted resected a segment of the second portion of the duodenum, including the tumor, and anastomosed the duodenum end to end. He then reimplanted the bile and pancreatic ducts. The first successful regional resection for a periampullary tumor was performed by the German surgeon from Berlin, Kausch, in 1909, and reported in 1912.2 The regional operative procedure for periampullary tumors was popularized by Whipple in a paper published in 1935.3 In this paper, 3 patients were reported who underwent regional resection performed in 2 stages. Two of the 3 patients survived. Between 1912 and Whipple’s report in 1935, a small number of patients in Europe underwent a regional resection of a periampullary tumor successfully. Following Whipple’s report, the operative procedure became widely known but was still infrequently performed. By the end of Whipple’s career, he had only performed 37 such procedures.4 During the 1960s and 1970s, few pancreaticoduodenectomies were performed because of a hospital mortality in the range of 25%. However, during the 1980s and 1990s, experience performing pancreaticoduodenectomy increased, and large volume “centers of excellence” developed. These high-volume centers acquired a substantial experience, and mortality decreased to below 5%.5–8 In recent years at the Johns Hopkins Hospital, more than 200 pancreaticoduodenectomies have been performed annually. This has allowed individual surgeons to develop significant experiences. Between 1969 and 2003, 1000 consecutive pancreaticoduodenectomies were performed by a single surgeon (J.L.C.) at the Johns Hopkins Hospital. This report reviews that experience and documents the changes that have occurred with this operative procedure over 5 decades.
  • References (17)
  • Citations (852)
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References17
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#1Charles J. Yeo (Johns Hopkins University)H-Index: 127
#2John L. Cameron (Johns Hopkins University)H-Index: 118
Last. Ralph H. Hruban (Johns Hopkins University)H-Index: 163
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Pancreaticoduodenectomy (the Whipple procedure) is the traditional resectional procedure for patients with periampullary adenocarcinoma (carcinoma of the head, neck, or uncinate process of the pancreas; ampulla of Vater; distal common bile duct; or peri-Vaterian duodenum). The outcomes of patients undergoing surgical resection depend on various tumor-specific factors 1–7 (e.g., primary tumor location, tumor size, status of resection margins and the presence or absence of lymph node metastases), ...
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#1Markus W. BüchlerH-Index: 127
#2Claudio BassiH-Index: 80
Last. Klempa IH-Index: 1
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#1Charles J. Yeo (Johns Hopkins University)H-Index: 127
#2John L. Cameron (Johns Hopkins University)H-Index: 118
Last. Michael A. Choti (Johns Hopkins University)H-Index: 85
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Pancreaticoduodenectomy is a commonly performed surgical procedure at many institutions, being used for various malignant and benign diseases of the pancreas and periampullary region. In many centers the perioperative death rate for pancreaticoduodenectomy is now less than 5%, 1–5 with the leading causes of postoperative death hemorrhage, cardiac events, and sepsis. 6 In contrast to this low death rate, the incidence of major postoperative complications after pancreaticoduodenectomy approaches 4...
402 CitationsSource
#1Keith D. Lillemoe (Johns Hopkins University)H-Index: 96
#2John L. Cameron (Johns Hopkins University)H-Index: 118
Last. Charles J. Yeo (Johns Hopkins University)H-Index: 127
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Objective This prospective, randomized, single-institution trial was designed to evaluate the role of prophylactic gastrojejunostomy in patients found at exploratory laparotomy to have unresectable periampullary carcinoma.
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#1Julie A. Sosa (Johns Hopkins University)H-Index: 55
#2Helen M. Bowman (Johns Hopkins University)H-Index: 11
Last. John L. CameronH-Index: 13
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OBJECTIVE: To determine whether hospital volume is associated with clinical and economic outcomes for patients with pancreatic cancer who underwent pancreatic resection, palliative bypass, or endoscopic or percutaneous stent procedures in Maryland between 1990 and 1995. SUMMARY BACKGROUND DATA: Previous studies have demonstrated that outcomes for patients undergoing a Whipple procedure improve with higher surgical volume, but only 20% to 35% of patients with pancreatic cancer qualify for curativ...
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#1Toby A. GordonH-Index: 20
#2Helen M. Bowman (Johns Hopkins University)H-Index: 11
Last. John L. CameronH-Index: 118
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OBJECTIVE: This study examined a statewide trend in Maryland toward regionalization of pancreaticoduodenectomy over a 12-year period and its effect on statewide in-hospital mortality rates for this procedure. SUMMARY BACKGROUND DATA: Previous studies have demonstrated that the best outcomes are achieved in centers performing large numbers of pancreaticoduodenectomies, which suggests that regionalization could lower the overall in-hospital mortality rate for this procedure. METHODS: Maryland stat...
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#1Charles J. Yeo (Johns Hopkins University)H-Index: 127
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Last. Henry A. PittH-Index: 61
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Objective The authors hypothesized that pancreaticogastrostomy is safer than pancreaticojejunostomy after pancreaticoduodenectomy and less likely to be associated with a postoperative pancreatic fistula. Summary Background Data Pancreatic fistula is a leading cause of morbidity and mortality after pancreaticoduodenectomy, occurring in 10% to 20% of patients. Nonrandomized reports have suggested that pancreaticogastrostomy is less likely than pancreaticojejunostomy to be associated with postopera...
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PurposeThe effects of regionalization of tertiary care were studied by analyzing cost and outcome for pancreaticoduodenectomies in a state in which the majority of these high-risk procedures were performed in one hospital.MethodsUsing Maryland inpatient discharge data via a retrospective study, the
381 CitationsSource
#2Harold KilburnH-Index: 11
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