Pancreaticoduodenectomy: Outcomes in a Low-Volume, Specialised Hepato Pancreato Biliary Unit
Background This study was designed to evaluate the outcomes of pancreaticoduodenectomy (PD) at a low-volume specialised Hepato Pancreato Biliary (HPB) unit. Volume outcome analyses show significantly better results for patients undergoing PD at high-volume centres (Begg et al. JAMA 280:1747–1751, 19...
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| Veröffentlicht in: | World journal of surgery 2014-06, Vol.38 (6), p.1484-1490 |
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| creator | Kanhere, H. A. Trochsler, M. I. Kanhere, M. H. Lord, A. N. Maddern, G. J. |
| description | Background
This study was designed to evaluate the outcomes of pancreaticoduodenectomy (PD) at a low-volume specialised Hepato Pancreato Biliary (HPB) unit. Volume outcome analyses show significantly better results for patients undergoing PD at high-volume centres (Begg et al. JAMA 280:1747–1751,
1998
; Finlayson et al. Arch Surg 138:721–725,
2003
; Birkmeyer et al. N Engl J Med 346:1128–1137,
2002
; Gouma et al. Ann Surg 232:786–795,
2000
). Centralisation of PD seems to be the logical conclusion to be drawn from these results. In countries like Australia with a small and widely dispersed population, centralisation may not be always feasible. Alternative strategy would be to have similar systems in place to those in high-volume centres to achieve similar results at low-volume centres. Many Australian tertiary care centres perform low to medium volumes of PD (Chen et al. HPB 12:101–108,
2010
; Kwok et al. ANZ J Surg 80:605–608,
2010
; Barnett and Collier ANZ J Surg 76:563–568,
2006
; Samra et al. Hepatobiliary Pancreat Dis Int 10:415–421,
2011
). Most of these have a specialised HPB unit, accredited by the Australia and New Zealand Hepatic pancreatic and biliary association (ANZHPBA), as training units for post fellowship training in HPB surgery. It is imperative to perform outcome-based analyses in these units to ensure safety and high quality of care.
Methods
Retrospective analysis of database for periampullary carcinoma (1998 till date) was performed in an ANZHPBA accredited HPB unit based at a tertiary care teaching hospital in South Australia. Because age older than 74 years is shown to be a predictive marker of increased morbidity and mortality after a PD, we analysed the outcomes in this subset of patients separately.
Results
Fifty-three patients underwent PD in 14 years. Overall mortality was 3.8 %. The last in hospital mortality was in 1999. The morbidity rates and the oncologic outcomes were similar to those in high-volume units.
Conclusions
PD can be safely performed in a low-volume specialised unit at centres where the amenities and processes at high-volume centres can be replicated. |
| doi_str_mv | 10.1007/s00268-013-2431-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1523406193</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1523406193</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4653-9ff4b66f819286b84712be0c377ee2530b98df455d7d8e86bd1832a87de655d93</originalsourceid><addsrcrecordid>eNqFkE9r2zAchkXZWNJ0H2CXIdilh7rVH1uWe2tLs3YEUui6XgZCln4eKraVWjYl374yTsYYlJ4kxPO-vHoQ-kLJKSUkPwuEMCETQnnCUk6T4gDNacpZwjjjH9CccJHGO-UzdBjCEyE0F0R8QrNI5zLL6Bz9vtOt6UD3zng7eAstmN4323O8HnrjGwjYtVjjlX9Jfvl6aOAE32_AOF27ABbfwEb3Hu9bPL50tdPdFj-0rj9CHytdB_i8OxfoYXn98-omWa2_315drBKTiownRVWlpRCVpAWTopRpTlkJxPA8B2AZJ2UhbZVmmc2thEhYKjnTMrcg4mPBF-h46t10_nmA0KvGBQN1rVvwQ1A0YzwlghY8ot_-Q5_80LVx3UhRWcioKFJ0okznQ-igUpvONfFbihI1qleTehXVq1G9Gkd83TUPZQP2b2LvOgLFBLy4GrbvN6rHH_eXSyIkH2ezKRtirP0D3T-z31z0CowLnic</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1521898760</pqid></control><display><type>article</type><title>Pancreaticoduodenectomy: Outcomes in a Low-Volume, Specialised Hepato Pancreato Biliary Unit</title><source>Wiley Online Library - AutoHoldings Journals</source><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Kanhere, H. A. ; Trochsler, M. I. ; Kanhere, M. H. ; Lord, A. N. ; Maddern, G. J.</creator><creatorcontrib>Kanhere, H. A. ; Trochsler, M. I. ; Kanhere, M. H. ; Lord, A. N. ; Maddern, G. J.</creatorcontrib><description>Background
This study was designed to evaluate the outcomes of pancreaticoduodenectomy (PD) at a low-volume specialised Hepato Pancreato Biliary (HPB) unit. Volume outcome analyses show significantly better results for patients undergoing PD at high-volume centres (Begg et al. JAMA 280:1747–1751,
1998
; Finlayson et al. Arch Surg 138:721–725,
2003
; Birkmeyer et al. N Engl J Med 346:1128–1137,
2002
; Gouma et al. Ann Surg 232:786–795,
2000
). Centralisation of PD seems to be the logical conclusion to be drawn from these results. In countries like Australia with a small and widely dispersed population, centralisation may not be always feasible. Alternative strategy would be to have similar systems in place to those in high-volume centres to achieve similar results at low-volume centres. Many Australian tertiary care centres perform low to medium volumes of PD (Chen et al. HPB 12:101–108,
2010
; Kwok et al. ANZ J Surg 80:605–608,
2010
; Barnett and Collier ANZ J Surg 76:563–568,
2006
; Samra et al. Hepatobiliary Pancreat Dis Int 10:415–421,
2011
). Most of these have a specialised HPB unit, accredited by the Australia and New Zealand Hepatic pancreatic and biliary association (ANZHPBA), as training units for post fellowship training in HPB surgery. It is imperative to perform outcome-based analyses in these units to ensure safety and high quality of care.
Methods
Retrospective analysis of database for periampullary carcinoma (1998 till date) was performed in an ANZHPBA accredited HPB unit based at a tertiary care teaching hospital in South Australia. Because age older than 74 years is shown to be a predictive marker of increased morbidity and mortality after a PD, we analysed the outcomes in this subset of patients separately.
Results
Fifty-three patients underwent PD in 14 years. Overall mortality was 3.8 %. The last in hospital mortality was in 1999. The morbidity rates and the oncologic outcomes were similar to those in high-volume units.
Conclusions
PD can be safely performed in a low-volume specialised unit at centres where the amenities and processes at high-volume centres can be replicated.</description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-013-2431-9</identifier><identifier>PMID: 24378551</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Abdominal Surgery ; Age Factors ; Aged ; Animals ; Australia ; Cardiac Surgery ; Cohort Studies ; Complex Surgery ; Female ; Follow-Up Studies ; General Surgery ; Hospital Mortality ; Humans ; Intraductal Papillary Mucinous Tumour ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; National Surgical Quality Improvement Program ; Pancreatic Fistula ; Pancreatic Neoplasms - mortality ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - surgery ; Pancreaticoduodenectomy - adverse effects ; Pancreaticoduodenectomy - methods ; Pancreaticoduodenectomy - mortality ; Postoperative Complications - mortality ; Postoperative Complications - physiopathology ; Retrospective Studies ; Risk Assessment ; Sex Factors ; Surgery ; Surgery Department, Hospital - statistics & numerical data ; Surgical Expertise ; Thoracic Surgery ; Time Factors ; Treatment Outcome ; Vascular Surgery ; Workload</subject><ispartof>World journal of surgery, 2014-06, Vol.38 (6), p.1484-1490</ispartof><rights>Société Internationale de Chirurgie 2013</rights><rights>2014 The Author(s) under exclusive licence to Société Internationale de Chirurgie</rights><rights>Société Internationale de Chirurgie 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4653-9ff4b66f819286b84712be0c377ee2530b98df455d7d8e86bd1832a87de655d93</citedby><cites>FETCH-LOGICAL-c4653-9ff4b66f819286b84712be0c377ee2530b98df455d7d8e86bd1832a87de655d93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00268-013-2431-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00268-013-2431-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,41488,42557,45574,45575,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24378551$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kanhere, H. A.</creatorcontrib><creatorcontrib>Trochsler, M. I.</creatorcontrib><creatorcontrib>Kanhere, M. H.</creatorcontrib><creatorcontrib>Lord, A. N.</creatorcontrib><creatorcontrib>Maddern, G. J.</creatorcontrib><title>Pancreaticoduodenectomy: Outcomes in a Low-Volume, Specialised Hepato Pancreato Biliary Unit</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>World J Surg</addtitle><description>Background
This study was designed to evaluate the outcomes of pancreaticoduodenectomy (PD) at a low-volume specialised Hepato Pancreato Biliary (HPB) unit. Volume outcome analyses show significantly better results for patients undergoing PD at high-volume centres (Begg et al. JAMA 280:1747–1751,
1998
; Finlayson et al. Arch Surg 138:721–725,
2003
; Birkmeyer et al. N Engl J Med 346:1128–1137,
2002
; Gouma et al. Ann Surg 232:786–795,
2000
). Centralisation of PD seems to be the logical conclusion to be drawn from these results. In countries like Australia with a small and widely dispersed population, centralisation may not be always feasible. Alternative strategy would be to have similar systems in place to those in high-volume centres to achieve similar results at low-volume centres. Many Australian tertiary care centres perform low to medium volumes of PD (Chen et al. HPB 12:101–108,
2010
; Kwok et al. ANZ J Surg 80:605–608,
2010
; Barnett and Collier ANZ J Surg 76:563–568,
2006
; Samra et al. Hepatobiliary Pancreat Dis Int 10:415–421,
2011
). Most of these have a specialised HPB unit, accredited by the Australia and New Zealand Hepatic pancreatic and biliary association (ANZHPBA), as training units for post fellowship training in HPB surgery. It is imperative to perform outcome-based analyses in these units to ensure safety and high quality of care.
Methods
Retrospective analysis of database for periampullary carcinoma (1998 till date) was performed in an ANZHPBA accredited HPB unit based at a tertiary care teaching hospital in South Australia. Because age older than 74 years is shown to be a predictive marker of increased morbidity and mortality after a PD, we analysed the outcomes in this subset of patients separately.
Results
Fifty-three patients underwent PD in 14 years. Overall mortality was 3.8 %. The last in hospital mortality was in 1999. The morbidity rates and the oncologic outcomes were similar to those in high-volume units.
Conclusions
PD can be safely performed in a low-volume specialised unit at centres where the amenities and processes at high-volume centres can be replicated.</description><subject>Abdominal Surgery</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Animals</subject><subject>Australia</subject><subject>Cardiac Surgery</subject><subject>Cohort Studies</subject><subject>Complex Surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>General Surgery</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Intraductal Papillary Mucinous Tumour</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>National Surgical Quality Improvement Program</subject><subject>Pancreatic Fistula</subject><subject>Pancreatic Neoplasms - mortality</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Pancreaticoduodenectomy - adverse effects</subject><subject>Pancreaticoduodenectomy - methods</subject><subject>Pancreaticoduodenectomy - mortality</subject><subject>Postoperative Complications - mortality</subject><subject>Postoperative Complications - physiopathology</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Sex Factors</subject><subject>Surgery</subject><subject>Surgery Department, Hospital - statistics & numerical data</subject><subject>Surgical Expertise</subject><subject>Thoracic Surgery</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Vascular Surgery</subject><subject>Workload</subject><issn>0364-2313</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFkE9r2zAchkXZWNJ0H2CXIdilh7rVH1uWe2tLs3YEUui6XgZCln4eKraVWjYl374yTsYYlJ4kxPO-vHoQ-kLJKSUkPwuEMCETQnnCUk6T4gDNacpZwjjjH9CccJHGO-UzdBjCEyE0F0R8QrNI5zLL6Bz9vtOt6UD3zng7eAstmN4323O8HnrjGwjYtVjjlX9Jfvl6aOAE32_AOF27ABbfwEb3Hu9bPL50tdPdFj-0rj9CHytdB_i8OxfoYXn98-omWa2_315drBKTiownRVWlpRCVpAWTopRpTlkJxPA8B2AZJ2UhbZVmmc2thEhYKjnTMrcg4mPBF-h46t10_nmA0KvGBQN1rVvwQ1A0YzwlghY8ot_-Q5_80LVx3UhRWcioKFJ0okznQ-igUpvONfFbihI1qleTehXVq1G9Gkd83TUPZQP2b2LvOgLFBLy4GrbvN6rHH_eXSyIkH2ezKRtirP0D3T-z31z0CowLnic</recordid><startdate>201406</startdate><enddate>201406</enddate><creator>Kanhere, H. A.</creator><creator>Trochsler, M. I.</creator><creator>Kanhere, M. H.</creator><creator>Lord, A. N.</creator><creator>Maddern, G. J.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>201406</creationdate><title>Pancreaticoduodenectomy: Outcomes in a Low-Volume, Specialised Hepato Pancreato Biliary Unit</title><author>Kanhere, H. A. ; Trochsler, M. I. ; Kanhere, M. H. ; Lord, A. N. ; Maddern, G. J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4653-9ff4b66f819286b84712be0c377ee2530b98df455d7d8e86bd1832a87de655d93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Abdominal Surgery</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Animals</topic><topic>Australia</topic><topic>Cardiac Surgery</topic><topic>Cohort Studies</topic><topic>Complex Surgery</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>General Surgery</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Intraductal Papillary Mucinous Tumour</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>National Surgical Quality Improvement Program</topic><topic>Pancreatic Fistula</topic><topic>Pancreatic Neoplasms - mortality</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Pancreaticoduodenectomy - adverse effects</topic><topic>Pancreaticoduodenectomy - methods</topic><topic>Pancreaticoduodenectomy - mortality</topic><topic>Postoperative Complications - mortality</topic><topic>Postoperative Complications - physiopathology</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Sex Factors</topic><topic>Surgery</topic><topic>Surgery Department, Hospital - statistics & numerical data</topic><topic>Surgical Expertise</topic><topic>Thoracic Surgery</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Vascular Surgery</topic><topic>Workload</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kanhere, H. A.</creatorcontrib><creatorcontrib>Trochsler, M. I.</creatorcontrib><creatorcontrib>Kanhere, M. H.</creatorcontrib><creatorcontrib>Lord, A. N.</creatorcontrib><creatorcontrib>Maddern, G. J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kanhere, H. A.</au><au>Trochsler, M. I.</au><au>Kanhere, M. H.</au><au>Lord, A. N.</au><au>Maddern, G. J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pancreaticoduodenectomy: Outcomes in a Low-Volume, Specialised Hepato Pancreato Biliary Unit</atitle><jtitle>World journal of surgery</jtitle><stitle>World J Surg</stitle><addtitle>World J Surg</addtitle><date>2014-06</date><risdate>2014</risdate><volume>38</volume><issue>6</issue><spage>1484</spage><epage>1490</epage><pages>1484-1490</pages><issn>0364-2313</issn><eissn>1432-2323</eissn><abstract>Background
This study was designed to evaluate the outcomes of pancreaticoduodenectomy (PD) at a low-volume specialised Hepato Pancreato Biliary (HPB) unit. Volume outcome analyses show significantly better results for patients undergoing PD at high-volume centres (Begg et al. JAMA 280:1747–1751,
1998
; Finlayson et al. Arch Surg 138:721–725,
2003
; Birkmeyer et al. N Engl J Med 346:1128–1137,
2002
; Gouma et al. Ann Surg 232:786–795,
2000
). Centralisation of PD seems to be the logical conclusion to be drawn from these results. In countries like Australia with a small and widely dispersed population, centralisation may not be always feasible. Alternative strategy would be to have similar systems in place to those in high-volume centres to achieve similar results at low-volume centres. Many Australian tertiary care centres perform low to medium volumes of PD (Chen et al. HPB 12:101–108,
2010
; Kwok et al. ANZ J Surg 80:605–608,
2010
; Barnett and Collier ANZ J Surg 76:563–568,
2006
; Samra et al. Hepatobiliary Pancreat Dis Int 10:415–421,
2011
). Most of these have a specialised HPB unit, accredited by the Australia and New Zealand Hepatic pancreatic and biliary association (ANZHPBA), as training units for post fellowship training in HPB surgery. It is imperative to perform outcome-based analyses in these units to ensure safety and high quality of care.
Methods
Retrospective analysis of database for periampullary carcinoma (1998 till date) was performed in an ANZHPBA accredited HPB unit based at a tertiary care teaching hospital in South Australia. Because age older than 74 years is shown to be a predictive marker of increased morbidity and mortality after a PD, we analysed the outcomes in this subset of patients separately.
Results
Fifty-three patients underwent PD in 14 years. Overall mortality was 3.8 %. The last in hospital mortality was in 1999. The morbidity rates and the oncologic outcomes were similar to those in high-volume units.
Conclusions
PD can be safely performed in a low-volume specialised unit at centres where the amenities and processes at high-volume centres can be replicated.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>24378551</pmid><doi>10.1007/s00268-013-2431-9</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | World journal of surgery, 2014-06, Vol.38 (6), p.1484-1490 |
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| source | Wiley Online Library - AutoHoldings Journals; MEDLINE; SpringerNature Journals |
| subjects | Abdominal Surgery Age Factors Aged Animals Australia Cardiac Surgery Cohort Studies Complex Surgery Female Follow-Up Studies General Surgery Hospital Mortality Humans Intraductal Papillary Mucinous Tumour Male Medicine Medicine & Public Health Middle Aged National Surgical Quality Improvement Program Pancreatic Fistula Pancreatic Neoplasms - mortality Pancreatic Neoplasms - pathology Pancreatic Neoplasms - surgery Pancreaticoduodenectomy - adverse effects Pancreaticoduodenectomy - methods Pancreaticoduodenectomy - mortality Postoperative Complications - mortality Postoperative Complications - physiopathology Retrospective Studies Risk Assessment Sex Factors Surgery Surgery Department, Hospital - statistics & numerical data Surgical Expertise Thoracic Surgery Time Factors Treatment Outcome Vascular Surgery Workload |
| title | Pancreaticoduodenectomy: Outcomes in a Low-Volume, Specialised Hepato Pancreato Biliary Unit |
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