• Markus W Büchler, Markus Wagner, Bruno M Schmied, Waldemar Uhl, Helmut Friess, and Kaspar Z'graggen.
• Department of Visceral and Transplantation Surgery, University of Bern, Inselspital, Switzerland. markus_buechler@med.uni-heidelberg.de
• Arch Surg Chicago. 2003 Dec 1; 138 (12): 1310-4; discussion 1315.

HypothesisAdvances in specialized centers for pancreatic diseases have improved surgical morbidity and outcome. In the past, postoperative local complications (pancreatic fistulae) were causing most of the mortality. Now, more patients experience postoperative complications related to their comorbidity.DesignTo report a prospective audit of a single center's experience with pancreatic resection during an 8-year period.SettingTertiary referral center focused on pancreatic diseases.Patients And InterventionsSix hundred seventeen consecutive patients underwent pancreatectomy between November 1, 1993, and August 31, 2001. The series included 468 pancreatic head resections (76%), 25 total pancreatectomies (4%), 88 left-sided resections (14%), and 36 others (6%).Main Outcome MeasuresMorbidity after pancreatic resection.ResultsPostoperative in-hospital mortality was 1.6%, and the additional operation rate was 4.1%. Four patients died of surgical complications and 6 of systemic complications. Systemic morbidity was 18% and consisted primarily of cardiopulmonary complications (13%). The most frequent postoperative complication was delayed gastric emptying (14%), which caused significant prolongation of the hospital stay. No patients died of a postoperative pancreatic fistula, which occurred in 3.2%, and no completion pancreatectomies were necessary.ConclusionsPancreatic resections can be performed with considerable safety and a low rate of pancreatic complications. More patients die of systemic complications than in the past, which increases the demand for precise preoperative patient selection. Completion pancreatectomy should no longer be considered in patients with a pancreatic fistula.

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