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Standards of pancreaticoduodenectomy in a tertiary
referral centre in Hong Kong: retrospective case series
RTP Poon, ST Fan, KM Chu,
JTC Poon, J Wong
Department of Surgery, The University of Hong Kong, Queen Mary Hospital,
102 Pokfulam Road, Hong Kong
OBJECTIVE. To evaluate the perioperative outcomes
of pancreaticoduodenectomy in a tertiary referral centre in Hong
Kong.
DESIGN. Retrospective case series.
SETTING. University teaching hospital, Hong Kong.
PATIENTS. One hundred and forty patients who underwent pancreaticoduodenectomy
from July 1989 through June 2001.
MAIN OUTCOME MEASURES. Mortality and morbidity.
RESULTS. Overall hospital mortality among 140 patients was 2.9%
(n=4), and 30-day operative mortality was 2.1% (n=3). There was
no significant difference in the hospital mortality rate between
43 elderly patients aged 70 years or older and 97 younger patients
(2.3% versus 3.1%). The overall morbidity rate was 38.6% (n=54).
Intra-abdominal abscess (13.6%) and pancreaticojejunal anastomotic
leakage (12.9%) were the two most common complications. Presence
of co-morbid illness (risk ratio, 2.823; 95% confidence interval,
1.541-4.385; P=0.01), preoperative cholangitis (risk ratio, 2.565;
95% confidence interval, 1.166-5.643; P=0.02), and intra-operative
blood loss �1.5 L (risk ratio, 2.236; 95% confidence interval, 1.132-6.213;
P=0.03) were independent risk factors for postoperative morbidity.
CONCLUSIONS. Pancreaticoduodenectomy is associated with a low risk
of operative death when performed in a tertiary referral setting
in Hong Kong. The postoperative morbidity rate remains high, however.
Further improvement by reducing intra-operative blood loss may help
curtail the high postoperative morbidity.
Hong Kong Med J 2002;8:249-54
Key words: Morbidity; Mortality; Pancreaticoduodenectomy
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