Whipple procedure at the University Hospital of North Norway (UNN)

Abstract

Background Pancreatic cancer is the fourth most common cause of cancer-related death in Norway. At the University Hospital of North Norway (UNN) Tromsø, the Whipple procedure is the preferred method of treating resectable pancreatic cancer. Results after surgical treatment are dependent on the volume of procedures undertaken, and UNN Tromsø is considered a low-volume hospital. Our hypothesis is that a low-volume hospital such as UNN Tromsø can accomplish Whipple procedure with acceptable levels of complications and survival rates. Material and methods Outcomes after all Whipple procedures performed between 2008 and 2017 at UNN Tromsø were collected from all hospitals in northern Norway. Descriptive statistics, a chi-square test, multiple and linear regression analyses, Kaplan–Meier survival analyses, and the log-rank test were performed to describe the data material. The Whipple procedure was performed on 156 patients: 91 (58.3%) men. Average age was 66.3 years (SD 10.2). Results An R0 resection margin was achieved in 112 (71.8%) of the procedures. 90 (57.7%) patients were discharged to non-index hospitals. 32 (20.5%) patients were readmitted during the first 30 postoperative days, and 36 (23.1%) patients were reoperated on. 35.0% of the patients experienced an Accordion score of 3 or higher. Twenty (12.8%) patients experienced postoperative pancreatic fistula. Delayed gastric emptying was experienced in 31 (19.9%) patients, postoperative bile leakage in 10 (6.4%) patients, and postoperative hemorrhage in 10 (6.4%) patients. 74 (47.4%) patients had pancreatic ductal adenocarcinoma (PDAC) as a postoperative histology finding. During the period of follow-up, the postoperative 90-day mortality was 4 (2.6%) patients. The 5-year overall survival was 21.6% for PDAC patients. Conclusion With a 90-day postoperative mortality of 2.6% for all patients and a 5-year survival for PDAC patients of 21.6%, one may conclude that the treatment results are in line with international standards for high-volume centers.