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Pancreatoduodenectomy—current status of surgical and perioperative techniques in Germany

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Abstract

Background

Pancreatoduodenectomy in Germany is performed by a broad range of hospitals. A diversity of operative techniques is employed as no guidelines exist for intra- and perioperative management. We carried out a national survey to determine the de facto German standards for pancreatoduodenectomy, assess quality assurance measures, and identify relevant issues for further investigation.

Methods

A questionnaire evaluating major outcome variables, case load, preferred surgical procedures, and perioperative management during pancreatoduodenectomy was developed and sent to 211 German hospitals performing >12 pancreatoduodenectomies per year (requirement for certification as a pancreas center). Statistical analysis was carried out using the Fisher Exact, Mann–Whitney U, and Spearman tests.

Results

The final response rate was 86 % (182/211). The preferred technique and de facto German standard for pancreatoduodenectomy was pylorus-preserving pancreatoduodenectomy with pancreatojejunostomy carried out via duct-to-mucosa anastomosis with interrupted sutures using PDS 4.0. The minority of German pancreas centers were certified (18–48 %). The certification rate increased with higher capacity levels and case load (P < 0.05); however, significant correlations between the fistula rate and hospital case load, hospital capacity level, or hospital certification status were not seen.

Conclusion

This study revealed a distinct variety of management strategies for pancreatic surgery and available evidence-based data was not necessarily translated into clinical practice. The limited certification rate represented a shortcoming of quality assurance. The data emphasize the need for further trials to answer the questions whether hospital certifications and omission of drains improve outcome after pancreatoduodenectomy and for the establishment of guidelines for pancreatoduodenectomy.

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Abbreviations

CWPD:

Classic (Kausch-)Whipple pancreatoduodenectomy

DKG:

Deutsche Krebsgesellschaft, German Cancer Association

DGAV:

Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, German Association for General and Visceral Surgery

PD:

Pancreatoduodenectomy

PG:

Pancreatogastrostomy

PJ:

Pancreatojejunostomy

POD:

Postoperative day

POPF:

Postoperative pancreatic fistula

PPPD:

Pylorus-preserving pancreatoduodenectomy by Traverso–Longmire

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Acknowledgments

The authors thank Mrs. Ulrike Kein for her outstanding work in the mailing and documentation of the questionnaire. The project was funded by an unrestricted grant of the Foerderverein Peter Geiger, Beilstein, Germany.

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None.

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Authors and Affiliations

  1. Department of General and Visceral Surgery, University Hospital Muenster, Waldeyerstr.1, 48149, Muenster, Germany

    Christina Haane, Wolf Arif Mardin, Britta Schmitz, Sameer Dhayat, Richard Hummel, Norbert Senninger, Christina Schleicher & Soeren Torge Mees

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  1. Christina Haane
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  2. Wolf Arif Mardin
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Correspondence to Soeren Torge Mees.

Additional information

Christina Haane, Wolf Arif Mardin, and Christina Schleicher contributed equally to this study.

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Haane, C., Mardin, W.A., Schmitz, B. et al. Pancreatoduodenectomy—current status of surgical and perioperative techniques in Germany. Langenbecks Arch Surg 398, 1097–1105 (2013). https://doi.org/10.1007/s00423-013-1130-1

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