A 12-year retrospective study of pancreatic surgery in a large regional centre: A study of the surgical indications, safety, and long-term patient outcomes
Simeon Moore, Swazi Sharma, Peter Sheeran, Lisa Driscoll, Thampi Rawther, Alexa Seal, Nicholas Williams
Introduction:
Pancreatic resection remains the primary treatment for pancreatic malignancy. Pancreatic surgery is associated with significant morbidity and mortality rates. Current literature demonstrates patient outcomes are influenced by multiple factors: hospital volume, surgeon volume and experience, with the former used to argue for procedure centralisation. Due to Australia’s geographical and population distribution, many patients residing in remote, rural and regional areas, depend on regional hospitals. This 12-year, retrospective study of a single surgeon operating in a large regional centre, was conducted to assess patient surgical indication, patient safety and outcomes following pancreatic resection.
Methods:
A retrospective analysis of a prospectively maintained database was performed on patients undergoing a pancreatic resection between 01 July 2012, and 01 November 2024. The primary outcome was all-cause mortality at 30 days, 90 days, 1 year and 5 years. Secondary outcomes assessed were length of stay, hospital readmission, return to theatre, and return to intensive care unit (ICU). Complications were classified using the Clavien-Dindo (C-D) system.
Results:
A total of 86 patients underwent pancreatic resection. Of these, 46 (53%) underwent Whipple’s resection and 40 (47%) underwent distal pancreatectomy. Of this cohort 50 (58%) were males and 36 (42%) were females, with a mean age of 70.2 years. The average hospital stay was 13.1 days. The readmission rate was 9.3%, with return to theatre and ICU being 12.8% and 5.8%, respectively. The overall major complication rate (C-D score > 3) was 8%. The all-cause mortality rate was 2.3%, 3.6%, 14.8% and 27.5% for 30 days, 90 days, 1 year and 5-years, respectively.
Conclusion:
This study demonstrates that performing pancreatic surgery in a large regional centre did not lead to worse outcomes compared to national and global rates. As such, performing such operations should continue to service patients in regional Australia.