{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T10:56:49Z","timestamp":1711018609981},"reference-count":35,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2014,5,24]],"date-time":"2014-05-24T00:00:00Z","timestamp":1400889600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2014,5,24]],"date-time":"2014-05-24T00:00:00Z","timestamp":1400889600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2014,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The technical complexity of pancreatic resection has made it a specialized procedure performed in high\u2010volume centers. It has been shown that patients operated on in high\u2010volume pancreatobiliary centers have fewer complications and better survival. The purpose of this study was to share our experience with and report long\u2010term outcomes of pancreaticoduodenal resections performed in a low\u2010volume center in Pakistan.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data of patients who underwent pancreaticoduodenal resection for adenocarcinoma at our institute from 1999 to 2012 were reviewed. A total of 39 patients were included in the study. Variables included patients\u2019 clinical and histopathological characteristics. Outcome was determined based on complication rate, 30\u2010 and 90\u2010day mortality, disease\u2010free survival, and overall survival. For survival analysis, Kaplan\u2013Meier curves were used and significance was determined using a log rank test. Univariate Cox analysis was performed to determine significant factors for multivariate analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The majority of tumors [20 (51 %)] were moderate grade, T1\/T2 [20 (51 %)], ampullary adenocarcinomas [18 (46 %)]. Mean hospital stay was 14 \u00b1 8\u00a0days. The mean number of nodes removed was 13.9 \u00b1 6.9, while mean number of positive nodes was 1 \u00b1 1.7. Expected 5\u2010year overall survival and relapse\u2010free survival were 38 and 48 %, respectively. Overall 5\u2010year survival was significantly different with respect to nodal involvement, i.e., 47 vs. 28 % (<jats:italic>P<\/jats:italic> = 0.018). On univariate analysis, nodal involvement was the only factor associated with an increased risk of death (<jats:italic>P<\/jats:italic> = 0.02, hazard ratio [HR] 2.9, confidence interval [CI] 1.1\u20137.8).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Low\u2010volume centers are an acceptable alternate to high\u2010volume centers for performing pancreaticoduodenal resection in carefully selected patients. Efforts should be directed at developing specialized hepatobiliary centers in developing countries.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-014-2644-6","type":"journal-article","created":{"date-parts":[[2014,5,23]],"date-time":"2014-05-23T18:15:49Z","timestamp":1400868949000},"page":"2506-2513","update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Pancreaticoduodenal Resection for Malignancy in a Low\u2010volume Center: Long\u2010term Outcomes from a Developing Country"],"prefix":"10.1002","volume":"38","author":[{"given":"Abu Bakar Hafeez","family":"Bhatti","sequence":"first","affiliation":[{"name":"Department of Surgical Oncology Shaukat Khanum Memorial Cancer Hospital and Research Centre Lahore Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad Aasim","family":"Yusuf","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Shaukat Khanum Memorial Cancer Hospital and Research Centre Lahore Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Syed Ather Saeed","family":"Kazmi","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Shaukat Khanum Memorial Cancer Hospital and Research Centre Lahore Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aamir Ali","family":"Syed","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology Shaukat Khanum Memorial Cancer Hospital and Research Centre Lahore Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,5,24]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gassur.2006.08.018"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010193510000\u201000023"},{"key":"e_1_2_7_4_2","first-page":"681","article-title":"Resection of the head of the pancreas and duodenum for carcinoma. 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