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Whipple’s pancreaticoduodenectomy at a resource-poor, low-volume center in Trinidad and Tobago

BACKGROUND: Many authorities advocate for Whipple’s procedures to be performed in high-volume centers, but many patients in poor developing nations cannot access these centers. We sought to determine whether clinical outcomes were acceptable when Whipple’s procedures were performed in a low-volume,...

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Autores principales: Cawich, Shamir O, Thomas, Dexter A, Pearce, Neil W, Naraynsingh, Vijay
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9537505/
https://www.ncbi.nlm.nih.gov/pubmed/36212600
http://dx.doi.org/10.5306/wjco.v13.i9.738
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author Cawich, Shamir O
Thomas, Dexter A
Pearce, Neil W
Naraynsingh, Vijay
author_facet Cawich, Shamir O
Thomas, Dexter A
Pearce, Neil W
Naraynsingh, Vijay
author_sort Cawich, Shamir O
collection PubMed
description BACKGROUND: Many authorities advocate for Whipple’s procedures to be performed in high-volume centers, but many patients in poor developing nations cannot access these centers. We sought to determine whether clinical outcomes were acceptable when Whipple’s procedures were performed in a low-volume, resource-poor setting in the West Indies. AIM: To study outcomes of Whipple’s procedures in a pancreatic unit in the West Indies over an eight-year period from June 1, 2013 to June 30, 2021. METHODS: This was a retrospective study of all patients undergoing Whipple’s procedures in a pancreatic unit in the West Indies over an eight-year period from June 1, 2013 to June 30, 2021. RESULTS: This center performed an average of 11.25 procedures per annum. There were 72 patients in the final study population at a mean age of 60.2 years, with 52.7% having American Society of Anesthesiologists scores ≥ III and 54.1% with Eastern Cooperative Oncology Group scores ≥ 2. Open Whipple’s procedures were performed in 70 patients and laparoscopic assisted procedures in 2. Portal vein resection/reconstruction was performed in 19 (26.4%) patients. In patients undergoing open procedures there was 367 ± 54.1 min mean operating time, 1394 ± 656.8 mL mean blood loss, 5.24 ± 7.22 d mean intensive care unit stay and 15.1 ± 9.53 d hospitalization. Six (8.3%) patients experienced minor morbidity, 10 (14%) major morbidity and there were 4 (5.5%) deaths. CONCLUSION: This paper adds to the growing body of evidence that volume alone should not be used as a marker of quality for patients requiring Whipple’s procedures. Low volume centers in resource poor nations can achieve good short-term outcomes. This is largely due to the process of continuous, adaptive learning by the entire hospital.
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spelling pubmed-95375052022-10-08 Whipple’s pancreaticoduodenectomy at a resource-poor, low-volume center in Trinidad and Tobago Cawich, Shamir O Thomas, Dexter A Pearce, Neil W Naraynsingh, Vijay World J Clin Oncol Retrospective Study BACKGROUND: Many authorities advocate for Whipple’s procedures to be performed in high-volume centers, but many patients in poor developing nations cannot access these centers. We sought to determine whether clinical outcomes were acceptable when Whipple’s procedures were performed in a low-volume, resource-poor setting in the West Indies. AIM: To study outcomes of Whipple’s procedures in a pancreatic unit in the West Indies over an eight-year period from June 1, 2013 to June 30, 2021. METHODS: This was a retrospective study of all patients undergoing Whipple’s procedures in a pancreatic unit in the West Indies over an eight-year period from June 1, 2013 to June 30, 2021. RESULTS: This center performed an average of 11.25 procedures per annum. There were 72 patients in the final study population at a mean age of 60.2 years, with 52.7% having American Society of Anesthesiologists scores ≥ III and 54.1% with Eastern Cooperative Oncology Group scores ≥ 2. Open Whipple’s procedures were performed in 70 patients and laparoscopic assisted procedures in 2. Portal vein resection/reconstruction was performed in 19 (26.4%) patients. In patients undergoing open procedures there was 367 ± 54.1 min mean operating time, 1394 ± 656.8 mL mean blood loss, 5.24 ± 7.22 d mean intensive care unit stay and 15.1 ± 9.53 d hospitalization. Six (8.3%) patients experienced minor morbidity, 10 (14%) major morbidity and there were 4 (5.5%) deaths. CONCLUSION: This paper adds to the growing body of evidence that volume alone should not be used as a marker of quality for patients requiring Whipple’s procedures. Low volume centers in resource poor nations can achieve good short-term outcomes. This is largely due to the process of continuous, adaptive learning by the entire hospital. Baishideng Publishing Group Inc 2022-09-24 2022-09-24 /pmc/articles/PMC9537505/ /pubmed/36212600 http://dx.doi.org/10.5306/wjco.v13.i9.738 Text en ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Retrospective Study
Cawich, Shamir O
Thomas, Dexter A
Pearce, Neil W
Naraynsingh, Vijay
Whipple’s pancreaticoduodenectomy at a resource-poor, low-volume center in Trinidad and Tobago
title Whipple’s pancreaticoduodenectomy at a resource-poor, low-volume center in Trinidad and Tobago
title_full Whipple’s pancreaticoduodenectomy at a resource-poor, low-volume center in Trinidad and Tobago
title_fullStr Whipple’s pancreaticoduodenectomy at a resource-poor, low-volume center in Trinidad and Tobago
title_full_unstemmed Whipple’s pancreaticoduodenectomy at a resource-poor, low-volume center in Trinidad and Tobago
title_short Whipple’s pancreaticoduodenectomy at a resource-poor, low-volume center in Trinidad and Tobago
title_sort whipple’s pancreaticoduodenectomy at a resource-poor, low-volume center in trinidad and tobago
topic Retrospective Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9537505/
https://www.ncbi.nlm.nih.gov/pubmed/36212600
http://dx.doi.org/10.5306/wjco.v13.i9.738
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