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Original Article

IMJ. 2016; 8(2): 103-106


EARLY VS ELECTIVE PANCREATICODUODENECTOMY IN THE MANAGEMENT OF PANCREATIC CANCER

AZHAR SHABBIR, JAMES SCHNEIDER, MOMIN MALIK, BASSAM ALKARI, IRFAN AHMED.

Abstract
OBJECTIVE: To compare morbidity and mortality of pancreatico-duodenectomy in patients undergoing early surgery versus on the
routine elective waiting lists.
STUDY DESIGN: Retrospective interventional study.
PLACE AND DURATION: The study was conducted in Department of Hepato-pancreatico-biliary Surgery, Aberdeen Royal Infirmary, UK
from 1st June 2009 to 31st December 2011.
METHODOLOGY: All patients who underwent a pancreatic oduodenectomy were included. Data was collected to identify patients
who had undergone pancreatic oduodenectomy within 14 days of decision to operate and those afterwards. Further data collected
included age at surgery, pathology and node involvement, serum bilirubin prior to surgery, peri-operative blood loss, duration of
surgery, post-operative re-operations, drainage of collections and minor procedures, recurrence rate within 1 year and 18 month and
% survival with after 18 months of the surgery for patients with malignant disease.
RESULTS: The emergency population comprised of 47% patients and the elective population included 53% patients. The average ages
at surgery were 65.0 years versus 70.0 years old respectively. There were 3 re-operations in the emergency population and 2 reoperations
in the elective population. 50.0% patients in the emergency population were lymph node positive (N1-N3) versus 58.8%
elective patients. 8 patients in the emergency population and 10 elective pancreatic cancer patients had confirmed recurrence. The
average number of days between diagnosis and death for the emergency group was 354 days versus 398 days for the elective
population. The mortality rate within 18 months was 29.4% within 18 months for emergency group, compared to 57.9% for the
elective population.
CONCLUSIONS: Expeditious pancreatico-duodenectomy is associated with greater immediate post-operative morbidity and
increased rate of reoperation but overall survival in 18 months have been noted to be better but not statistically different as compared
to routine elective pancreaticoduodenectomy. However considering this a relatively small sample size, further studies with larger
numbers is needed to confirm this finding.

Key words: Pancreatico-Duodenectomy, Pancreatic Cancer, Waiting Times, Survival, Management.



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