One thousand consecutive pancreaticoduodenectomies and beyond: a personal series

A consecutive series of 1000 pancreaticoduodenectomies (PDs) performed by a single surgeon from 1969 to 2003 is reported. Patient ages ranged from 15 years to 103 years. The average age was 63 years. Seventy patients were in their 80s, one patient was in his 90s, and one patient was over 100. Overall morbidity was 41% and mortality, 1% (10 deaths). Five-year survival for the 39 patients undergoing a Whipple procedure for duodenal cancer was 52%, for the 113 patients with ampullary cancer 39%, and for the 95 patients with a cholangiocarcinoma 23%. Overall 5-year survival for the 405 patients undergoing a Whipple procedure for adenocarcinoma of the pancreas was 18%. Among the 64 patients with pancreatic cancer who were both margin-negative and node-negative, 5-year survival was 41%. The remaining 348 Whipple procedures were performed for a variety of benign and malignant diseases. Of the second 1000 Whipple procedures the author is working on, 428 have been performed. The latter population tends to be older with more extensive and serious comorbidities than the first 1000 patients.