Objective: To analyse hospital mortality, complications and survival of patients after subtotal pancreaticoduodenectomy in the Academic Medical Centre, Amsterdam, the Netherlands, 1983-1996.
Design: Partly retrospective (1983-August 1987), partly prospective (September 1987-1996).
Method: Patient characteristics, indication for surgery, postoperative complications, mortality and survival of patients who underwent subtotal pancreaticoduodenectomy were recorded in a computer database. Patients were subdivided into three groups (1983-September 1992; October 1992-1994; 1995-September 1996) to analyse the influence of change in surgical technique and the increase of experience.
Results: From 1983-to September 1996, 312 consecutive patients underwent a subtotal pancreaticoduodenectomy. Hospital mortality decreased from 4.9% to 1.4% in the last period (1995-1996). The complication rate decreased from 60% to 41%. The hospital stay decreased from median 24 days to 16 days. The actualized 5-year survival analysed for patients operated from 1983-to September 1992 was 31%. Patients with ampullary tumours had a 5-year survival of 50%. The 5-year survival of patients with bile duct and pancreatic carcinoma was 24% and 15% respectively.
Conclusions: Subtotal pancreaticoduodenectomy can be performed safely with a low mortality (< 2%) in specialised centres. The morbidity is still substantial (40%). The survival is mainly dependent on type of tumour and patient selection and is approximately 50% for patients with ampullary tumours. The pylorus preserving procedure has become the standard operation.