Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Sep 24, 2022; 13(9): 738-747
Published online Sep 24, 2022. doi: 10.5306/wjco.v13.i9.738
Whipple’s pancreaticoduodenectomy at a resource-poor, low-volume center in Trinidad and Tobago
Shamir O Cawich, Dexter A Thomas, Neil W Pearce, Vijay Naraynsingh
Shamir O Cawich, Dexter A Thomas, Vijay Naraynsingh, Department of Surgery, Port of Spain General Hospital, Port of Spain 000000, Trinidad and Tobago
Neil W Pearce, Department of Surgery, Southampton General Hospital National Health Services Trust, Southampton SO16 6YD, United Kingdom
Author contributions: Cawich SO, Naraynsingh V, Thomas D and Pearce NW designed and coordinated the study; Pearce NW, Thomas D and Naraynsingh V acquired and analyzed data; Cawich SO, Naraynsingh V, Thomas D and Pearce NW interpreted the data; Cawich SO, Naraynsingh V, Thomas D and Pearce NW wrote the manuscript; all authors approved the final version of the article.
Institutional review board statement: The study was reviewed and approved by the University of the West Indies Institutional Review Board (CREC-SA.1623/06/2022).
Informed consent statement: This was a retrospective audit of written hospital records and so informed consent was waived by the institutional review board.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: All data are available from the corresponding author upon reasonable request at tt.liver.surgery@gmail.com.
Open-Access: 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. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shamir O Cawich, FRCS, Full Professor, Department of Surgery, Port of Spain General Hospital, Charlotte Street Port of Spain, Port of Spain 000000, Trinidad and Tobago. tt.liver.surgery@gmail.com
Received: May 18, 2022
Peer-review started: May 18, 2022
First decision: July 14, 2022
Revised: July 22, 2022
Accepted: August 17, 2022
Article in press: August 17, 2022
Published online: September 24, 2022
Processing time: 126 Days and 12.8 Hours
Abstract
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.

Keywords: Pancreas; Surgery; Pancreatectomy; Whipple’s; Pancreaticoduodenectomy

Core Tip: Although conventional recommendations suggest that Whipple’s procedures should only be performed in high-volume centers, this is not practical in many nations. 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.