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

Table 1 American society of anesthesiologists scores for patients undergoing Whipple’s procedures in a low volume caribbean centre

Score	American Society of Anesthesiologists Descriptor	No (%)
I	Completely healthy	10 (13.9)
II	Mild systemic disease	24 (33.3)
III	Severe systemic disease that is not incapacitating	30 (41.7)
IV	Incapacitating disease that is a threat to life	8 (11.1)
V	Moribund and not expected to survive > 24 h	0

Table 2 Performance scores for patients undergoing Whipple’s procedures in a low volume caribbean centre

Grade	Eastern Cooperative Oncology Group performance status	No (%)
0	Fully active, able to carry out all activities without restriction	13 (18.1)
1	Restricted in physically strenuous activity, but ambulatory and able to carry out light work	20 (27.8)
2	Ambulatory and capable of self care, but unable to carry out work activities. Up and about > 50% of waking hours	34 (47.2)
3	Capable of limited self care and confined to bed or chair for more than 50% of waking hours	4 (5.6)
4	Completely disabled and cannot carry on self care. Confined to bed or chair	1 (1.4)
5	Dead	0

Table 3 Complications after Whipple’s procedures in a low volume caribbean centre

Morbidity	Description	No	%
Overall	Number of patients with any complication	16	22.2
Minor	Clavien-Dindo I or II	6	8.3
	Pneumonia	2
	Deep vein thrombosis	1
	Delayed gastric emptying	1
	Gastrointestinal bleeding	2
Major	Clavien-Dindo III or IV	10	13.9
	Anastomotic dehiscence	1
	Massive upper gastrointestinal bleeding	1
	Myocardial infarction	3
	Pseudoaneurysm	2
	Biliary sepsis as a source of septicemia	2
	Post-operative pancreatic fistula/intra-abdominal collection	1
Mortality	30-d mortality: All causes: (1) Massive bleeding from a pseudoaneurysm; (2) Generalized sepsis secondary to cholangitis; (3) Jejuno-jejunal anastomotic leak leading to multiple organ failure; and (4) Myocardial infarction	4	5.6

Table 4 Chronologic analysis of clinical outcomes after Whipple’s procedures in a low volume caribbean centre

Year	Case volume	Minor morbidity	Major morbidity	Mortality
2013-2014	9	0	1	1
2014-2015	10	1	2	0
2015-2016	11	1	3	0
2016-2017	8	1	1	1
2017-2018	10	1	2	1
2018-2019	8	0	0	0
2019-2020	11	1	1	1
2020-2021	5	1	0	0
Total	72	6 (8.3%)	10 (13.9)	4 (5.6%)

Table 5 Clinical outcomes stratified according to patient risk

American Society of Anesthesiologists scores
Parameter	ASA I-II (34)	ASA III-IV (38)	P
Overall morbidity	7 (20.6%)	9 (23.7%)	0.7843
Overall mortality	2 (5.9%)	2 (5.3%)	1.000
Eastern Cooperative Oncology Group performance status
Parameter	ECOG 0-2 (67)	ECOG 3-4 (5)	P
Overall morbidity	14 (20.9%)	2 (40%)	0.307
Overall mortality	3 (4.5%)	1 (20%)	0.255

ASA: American Society of Anesthesiologists; ECOG: Eastern Cooperative Oncology Group.