Pancreaticoduodenectomy

Abstract

Pancreaticoduodenectomy (PD) has its origins in the late 1800s. Although William Halsted¹ performed the first transduodenal local excision of a tumor of the ampulla of Vater in 1898, Alessandro Codivilla, in that same year, was the first to perform a PD, in Imola, Italy. In 1909 in Berlin, Walter Kausch² performed the first successful 2-stage PD. Allen Whipple et al³ reported the first series of PDs in 1935, and since that time, the operation has been known as the "Whipple" operation. Operative mortality from the original report of Whipple to well into the 1970s was in excess of 25%.^4-10 More recently, however, several series^11-14 have reported large numbers of consecutive Whipple procedures without mortality. In addition, the procedure has gained wide acceptance such that in the past decade, some centers have reported large series of Whipple procedures for a variety of benign and malignant periampullary conditions.^15,16 In such high-volume centers, with the standardization of perioperative care, advances in surgical technique, and interventional radiology and intensive care support, the procedure has become considerably safer.^17-19 Nonetheless, the long-term outcome of PD in patients with periampullary adenocarcinoma continues to be poor. A benchmark study¹⁵ from Johns Hopkins reported multivariate predictors of long-term survival in patients with periampullary adenocarcinoma that included diagnosis, number of additional surgeries, tumor size (>3 cm), tumor differentiation, tumor margin, and node status. Similarly, in this article we report a high-volume, single-institution experience during the past 20 years with PD in which we examined the effects of preoperative, perioperative, and pathological variables on long-term survival.