To analyze the perioperative curative effect of pancreaticoduodenectomy (PD) in a single center over two decades.

Clinical data of 523 patients who had complete medical record and underwent PD in Sun Yat-sen Memorial Hospital, Sun Yat-sen University between January 1994 and December 2013 were retrospectively analyzed. The patients were divided into the latter decade group and the former decade group according to the year when surgery was performed. Among the 396 patients in the latter decade group, 246 were males and 150 were females with the age ranging from 19 to 97 years old and the median of 58 years old. Among the 127 patients in the former decade group, 69 were males and 58 were females with the age ranging from 6 to 79 years old and the median of 56 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The perioperative conditions of two groups were compared and analyzed using rank sum test and the comparison of rate was conducted using Chi-square test.

The median length of surgery in the latter decade group was 340(187-920) min, significantly longer than 310(180-730) min in the former decade group (Z=3.12, P<0.05). The intraoperative blood loss in the latter decade group was 300(50-4 500) ml, significantly less than 600(200-18 000) ml in the former decade group (Z=-7.62, P<0.05). The postoperative length of stay in the latter decade group was 23(5-148) d, significantly shorter than 25(11-309) d in the former decade group (Z=-2.82, P<0.05). The perioperative mortality in the latter decade group was 6% (24/396), significantly lower than 12%(15/127) in the former decade group (χ²=4.61, P<0.05). The incidence of postoperative complications and the reoperation rate of the patients with postoperative complications in the latter decade group were respectively 39% (156/396) and 29%(45/156), while those in the former decade group were respectively 46% (58/127) and 16% (9/58). The reoperation rate in the latter decade group was significantly higher than that in the former decade group (χ²=3.98, P<0.05). The most common reason for reoperation was intra-abdominal hemorrhage.

PD has become a safe and effective operation as the intraoperative blood loss, the postoperative length of stay and the perioperative mortality decrease. Timely reoperation may has an important significance in reducing the perioperative mortality when severe postoperative complications happen.