One Thousand Consecutive Pancreaticoduodenectomies
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.