Whipples for pancreatic cancer – a multi-centred 10-year experience in regional victoria.

Abstract

Background/Purpose: Regional centres in Australia have grown in size and capabilities over the last decade. Some now have dedicated upper gastrointestinal units supported by multidisciplinary teams that are capable of managing pancreatic malignancies. However, the caseload encountered by these centres is deemed low volume. Recent evidence suggests improved clinical outcomes for pancreatic cancer (PC) managed in high-volume institutions. This drives the push for surgical management of PC to be ‘centralised’. Data relating to outcomes from regional Australian hospitals does not exist in the published literature. We aim to see if major operations, specifi cally Whipples procedure for PC can be safely performed in regional Australia. Methods: Retrospective analysis of patients receiving surgical management for pancreatic cancer between 2002 and 2012 in Geelong and Ballarat was performed. Data regarding TNM stage, 30-day mortality, margin status and 5-year survival rates were analysed. Comparisons were drawn to standards established at higher-volume institutions. Results: 55 patients underwent Whipples procedure for PC were included. Mean age was 68.75. Patient pathology was comparable to those of previous studies based on TNM stage. Hospital and surgeon volumes met criteria for low volume institutions. Outcomes were compared: 30-day mortality 3.77% vs 5.3%; Margin positivity was 20% vs 38.7% and 5-year surival rates were 10% vs 8% (Speer et al; MJA 2012; 196:511–515). Conclusion: Although controversy exists regarding where Whipples cases should be performed, this study demonstrates comparable outcomes to high volume centres. With good support and advice from our high-volume colleagues, the increase in intensive care and nursing experience and good nutritional support, our data suggest that Whipples can be safely performed in regional centres with established upper-gastrointestinal units and multidisciplinary team expertise.