LOW MORTALITY FOLLOWING RESECTION FOR PANCREATIC AND PERIAMPULLARY TUMORS IN 1026 PATIENTS - UK SURVEY OF SPECIALIST PANCREATIC UNITS

Background Recent studies have suggested that the mortality rate from pancreatic resection for cancer is high in the UK compared with that i n published series. A survey of specialist units was conducted to dete rmine whether the results differed from those in general units. Method s The postoperative outcome following resection of pancreatic and peri ampullary tumours was analysed from specialist units in the UK and com pared with that of other multi-institutional and large single institut ional studies published recently (1900-1996). Results A total of 1026 resections was reported from 21 units (33 surgeons). Postoperative com plications necessitated reoperation in 57 patients (6 per cent) and th ere were 58 deaths (6 per cent) in hospital. Pylorus-preserving resect ions were performed in 102 (41 per cent) of 250 patients with ampullar y adenocarcinoma undergoing a major right-sided resection and in 123 ( 32 per cent) of 381 patients with ductal adenocarcinoma of the head of the pancreas undergoing right-sided resection (chi(2) = 401, 1 d.f., 2P = 0.04). The mean number of resections for pancreatic ductal adenoc arcinoma was 3.41 (range 1.0-7.1) per institution per year. Combining these data with those from the nine published series from specialist u nits, there was a lower mortality rate compared with the results of fi ve published general surveys (median 4.9 per cent (95 per cent confide nce interval (c.i.) 3.1-8.0 per cent) versus 9.8 (2.5-23.2 per cent), 2P < 0.01) and specialist units had a higher volume caseload (median 5 .5 (95 per cent c.i. 4.2-8.1) versus 0.5 (-0.2-2.0) cases per institut ion per year, 2P < 0.001). Postoperative mortality was related to case load both for the UK (chi(2) = 7.17, 1 d.f., P < 0.01) and for all the data combined (chi(2) = 40.4, 1 d.f., P < 0.0001). Conclusion The res ults from specialist units in the UK compare favourably with these fro m specialist units outside the UK and are superior to those from non-s pecialist units. The mortality rate is generally lower in units with a higher caseload.