Characteristics of Pancreaticoduodenal Resection on Periampullary Tumor Cases by Jakarta Tertiary Hospital Team: Three Decade Report

Toar J. M. Lalisang, Yarman Mazni, Yefta Moenadjad, Sahat Matondang

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Abstract

Background: There were only few publications related to pancreaticoduodenal resection (PDR) /Whipple procedure in Indonesia in the past decade. Method: Retrospectively report of the characteristics and outcomes of PDR performed by Cipto Mangunkusumo Hospital surgical team from 1993 to 2017 were collected. Results: PDR were performed in 213 patients, with a mean age of 50.6 years and 54.4% patients were females. Predominant preoperative clinical findings were jaundice (68.9%) and mild hypoalbuminemia (69.9%). Biliary decompression was performed in 112 (52.6%) subjects. Average surgical waiting time was 3.5 months. While PDR were performed in 84 (39.5%) subjects, pyloric preserving pancreaticoduodenal technique was predominated in 128 (59.8) and predominated, especially during the latter years. Fifteen (9.0%) cases were benign. Thirty-one (14.6%) subjects underwent relaparotomy, 16 (51.6%) of whom died post-operatively. Overall operative mortality decreased from 16.9% to 5.5% in 2016, while resection rate generally increased over time, ranging from 2 - 21/year. Less than 10% of subjects survived for > 5 years, while < 20% survived for < 24 months. Overall morbidity was 65.1% in 177 survivors, with surgical site infection in 52.5%, pancreatic fistula in 24.2%, and post-pancreatectomy haemorrhage (PPH) as a fatal postoperative complication in 19 (8.9%) cases. Patients who died within 30 days postoperatively had significantly more relaparotomies and PPH (p < 0.001). Conclusion: Prolonged jaundice and mild hypoalbuminemia are dominant characteristics in our Indonesian PDR subjects. Cipto Mangunkusumo Hospital is a high-volume PDR centre and world class hospital. Mortality rates decreased with the increasing resection rates. Relaparotomy and PPH are predictors of poor outcome.
Original languageEnglish
JournalThe Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
Publication statusPublished - 2019

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