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
ARTICLE HIGHLIGHTS
Research background

Whipple's operations are high-risk operations that should be done in high-volume centers for optimal outcomes. This is supported by data from several high-volume hospitals.

Research motivation

High-volume centers are usually in developed nations. There are no high-volume centers in the West Indies. In this setting, pancreatic surgeons have to perform Whipple's operations in resource-poor, low-volume settings. This scenario is not ideal, but it is the reality on the ground.

Research objectives

We sought to document the clinical outcomes when Whipple's operations were performed in resource-poor, low-volume centers in the West Indies. If the outcomes are poor, this would be impetus not to perform these operations in this setting or to develop service centralization with high-volume centers.

Research methods

A retrospective audit of all Whipple's operation performed at a referral center over an eight-year period was performed. Data collected from hospital records included: diagnoses, performance scores, estimated operative blood loss, duration of operation, therapeutic outcomes, post-operative morbidity and mortality. Statistical analyses were performed using SPSS version 16.0.

Research results

This facility performed 11.25 Whipples procedures per annum. There were 72 patients in the final study population at a mean age of 60.2 years. 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.

Research conclusions

Low volume centers in resource poor nations can achieve good short-term outcomes once they pay attention to continuous, adaptive learning. Volume alone should not be used as a marker of quality for patients requiring Whipple’s procedures.

Research perspectives

The direction of future research is to identify specific hospital-based pathways and/or team-focused processes that improve clinical outcomes in low-volume facilities.