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Evolution of pancreatoduodenectomy in a tertiary cancer center in India: improved results from service reconfiguration

In Pancreatology
By: Shrikhande SV.
Contributor(s): Shukla PJ | Sirohi B | Shetty GS | Suradkar K | Somashekar BA | Barreto SG | shailushrikhande@hotmail.com.
Material type: materialTypeLabelArticleSeries: Vol 13 Issues 1.Publisher: 2013Description: 63-71.Subject(s): Standardization | Centralization | Volume | Mortality | Morbidity | Surgery In: PancreatologySummary: Background :Pancreatic cancer incidence in India is low. Over the years, refinements in technique of pancreatoduodenectomy (PD) may have improved outcomes. No data is available from India, South-Central, or South West Asia to assess the impact of these refinements. Purpose To assess the impact of service reconfiguration and standardized protocols on outcomes of PD in a tertiary cancer center in India. Methods Three specific time periods marking major shifts in practice and performance of PD were identified, viz. periods A (19922001; pancreaticogastrostomy predominantly performed), B (2003July 2009; standardization of pancreaticojejunal anastomosis), and C (August 2009December 2011; introduction of neoadjuvant chemo-radiotherapy and increased surgical volume). Results 500 PDs were performed with a morbidity and mortality rate of 33% and 5.4%, respectively. Over the three periods, volume of cases/year significantly increased from 16 to 60 (p < 0.0001). Overall incidence of post-operative pancre
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Articles Articles Tata Memorial Hospital
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Background :Pancreatic cancer incidence in India is low. Over the years, refinements in technique of pancreatoduodenectomy (PD) may have improved outcomes. No data is available from India, South-Central, or South West Asia to assess the impact of these refinements.

Purpose
To assess the impact of service reconfiguration and standardized protocols on outcomes of PD in a tertiary cancer center in India.

Methods
Three specific time periods marking major shifts in practice and performance of PD were identified, viz. periods A (19922001; pancreaticogastrostomy predominantly performed), B (2003July 2009; standardization of pancreaticojejunal anastomosis), and C (August 2009December 2011; introduction of neoadjuvant chemo-radiotherapy and increased surgical volume).

Results
500 PDs were performed with a morbidity and mortality rate of 33% and 5.4%, respectively. Over the three periods, volume of cases/year significantly increased from 16 to 60 (p < 0.0001). Overall incidence of post-operative pancre

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