Annals of surgery
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Multicenter Study
Perioperative mortality for pancreatectomy: a national perspective.
To analyze in-hospital mortality after pancreatectomy using a large national database. ⋯ This large observational study demonstrates an improvement in operative mortality for patients undergoing pancreatectomy for neoplastic disease from 1998 to 2003. In addition, a greater proportion of pancreatectomies were performed at high-volume centers in 2003. The regionalization of pancreatic surgery may have partially contributed to the observed decrease in mortality rates.
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Multicenter Study
National failure to operate on early stage pancreatic cancer.
Despite studies demonstrating improved outcomes, pessimism persists regarding the effectiveness of surgery for pancreatic cancer. Our objective was to evaluate utilization of surgery in early stage disease and identify factors predicting failure to undergo surgery. ⋯ This is the first study to characterize the striking underuse of pancreatectomy in the United States. Of early stage pancreatic cancer patients without any identifiable contraindications, 38.2% failed to undergo surgery.
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The correlation of the amylase value in drains (AVD) with the development of pancreatic fistula (PF) is still unclear. ⋯ AVD in POD1 > or =5000 U/L is the only significant predictive factor of PF development.
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To analyze clinical courses and outcome of postpancreatectomy hemorrhage (PPH) after major pancreatic surgery. ⋯ Prognosis of PPH depends mainly on the presence of preceding pancreatic fistula. Decision making as to the indication for nonsurgical interventions should consider time of onset, presence of pancreatic fistula, vascular pathologies, and the underlying disease.