CAJ | 학술논문

BACKGROUND:?Pancreatoduodenectomy? offers? the? only?chance? of? cure? for? patients? with? periampullary? cancers.?This,?however,?is?a?major?undertaking?in?most?patients?and?is? associated? with? a? significant? morbidity? and? mortality.? A?multidisciplinary?approach?to?the?workup?and?follow-up?of?patients? undergoing? pancreatoduodenectomy? was? initiated?at? our? institution? to? improve? the? diagnosis,? resection? rate,?mortality?and?morbidity.?We?undertook?the?study?to?assess?the?effect?of?this?approach?on?diagnosis,?resection?rates?and?short-term?outcomes?such?as?morbidity?and?mortality. <br> METHODS:?A? prospective? database? of? patients? presenting?with?periampullary?cancers?to?a?single?surgeon?between?April?2004?and?April?2010?was?reviewed.?All?cases?were?discussed?at?a?multidisciplinary?meeting?comprising?surgeons,?gastro-enterologists,?radiologists,?oncologists,?radiation?oncologists,?pathologists?and?nursing?staff.?A?standardized?investigation?and? management? algorithm? was? followed.? Complications?were?graded?according?to?the?Clavien-Dindo?classification. <br> RESULTS:?A?total?of?295?patients?with?a?periampullary?lesion?were? discussed? and? 178? underwent? pancreatoduodenectomy?(resection?rate?60%).?Sixty-one?patients?(34%)?required?either?a?vascular?or?an?additional?organ?resection.?Eighty-nine?patients?experienced?complications,?of?which?the?commonest?was?blood?transfusion? (12%).? Thirty-four? patients? (19%)? had? major?complications,?i.e.?grade?3?or?above.?There?was?no?in-hospital,?30-day?or?60-day?mortality. <br> CONCLUSIONS:?Pancreatoduodenectomy? can? safely? be?performed? in? high-volume? centers? with? very? low? mortality.?The? surgeon's? role? should? be? careful? patient? selection,?intensive?preoperative?investigations,?use?of?a?team?approach,?and?an?unbiased?discussion?at?a?multidisciplinary?meeting?to?optimize?the?outcome?in?these?patients.