Pancreaticoduodenectomy in Hong Kong: An Audit of the Queen Mary Hospital Experience

Pancreaticoduodenectomy is an established procedure for various periampullary cancers in Hong Kong. During the past decade, tumors at the head of the pancreas (27 patients), the ampulla (23 patients), and the distal bile duct (11 patients) constituted about 90% of the 68 patients who underwent the procedure at the Queen Mary Hospital. Preoperative biliary decompression was used selectively as analysis of the postoperative outcome of the 38 jaundiced patients who failed to demonstrate any benefit. During the past 2 years, diagnostic laparoscopy and a laparoscopic ultrasound examination were conducted routinely before laparotomy. In the absence of gastric outlet obstruction, patients with unresectable disease would be managed by nonoperative measures. While the techniques chosen by an individual surgeon varied, the majority of patients had an antrectomy (58 patients) and a pancreaticojejunostomy (66 patients). None of our patients had concomitant resection of the portal vein and superior mesenteric artery. Similar to recent reports, results of surgery improved over the years. In contrast to the overall hospital death rate of 5.8% the rate has dropped to 2.6% since 1990. Adjunctive therapies, including perioperative radiotherapy and systemic chemotherapy, were not given. The median survival of the 57 patients who were discharged from hospital after resection of their tumors was 26%, 16%, and 16% for patients with cancer of the ampulla (26 patients), head of the pancreas (17 patients), and distal bile duct (10 patients), respectively. Further studies are necessary to elucidate an effective means to improve the prognosis of these patients.