University of Oulu

Nortunen M, Meriläinen S, Ylimartimo A, Peroja P, Karjula H, Niemelä J, Saarela A, Huhta H. Evolution of pancreatic surgery over time and effects of centralization—a single-center retrospective cohort study. J Gastrointest Oncol 2023;14(1):366-378. doi: 10.21037/jgo-22-649

Evolution of pancreatic surgery over time and effects of centralization : a single-center retrospective cohort study

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Author: Nortunen, Minna1; Meriläiäinen, Sanna1; Ylimartimo, Aura1;
Organizations: 1Department of Surgery, Anesthesia and Intensive Care Research Unit, Oulu University Hospital, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
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Language: English
Published: AME Publishing Company, 2023
Publish Date: 2023-08-16


Background: Short-term outcomes of pancreatic surgery have improved globally during the last two decades. Long-term survival of resectable pancreatic ductal adenocarcinoma (PDAC) has also shown slight improvement. We describe a cohort of 566 consecutive pancreatectomies performed at a Northern Finnish tertiary center. We analyze the trends in short-term outcomes of all-cause pancreatic surgery and long-term survival of PDAC patients.

Methods: All pancreatic resections performed at the Oulu University Hospital during years 2000–2020 were included. Patient data was analyzed in four time periods (2000–2005, 2006–2010, 2011–2015 and 2016–2020). Clinicopathological parameters of patients and tumors, complication data and short-term mortality were recorded for all patients and compared between time quartiles. Long-term survival and administration rates of neo-, and/or adjuvant therapy of PDAC patients were analyzed.

Results: A total of 566 pancreatectomies were performed during the study period: 359 (63%) pancreatoduodenectomies (PDs), 130 (23.0%) open left pancreatectomies (LPs), 45 (8.0%) laparoscopic LPs, 26 (5.1%) total pancreatectomies (TPs), and 6 (1.1%) enucleations. Median age of patients was 63 [57–71] years, and 49% [267] of patients were men. Number of pancreatectomies per time period increased from 67 in 2000–2005 to 266 in 2016–2020. American Society of Anesthesiologists (ASA) Physical Classification III patients and T3 tumors were more frequently operated on in later time periods. Complication rates remained at constant low levels throughout the study period, but reoperation rate increased from 9.4% in 2000–2010 to 16.2% in 2011–2020. Short-term (90-day) mortality after pancreatectomy decreased from 3.1% to 0.74%, while 5-year survival improved from 14.3% in 2006–2011 to 21.4% in 2011–2015. Resection rate of diagnosed PDAC cases, as reported by the Finnish Cancer Registry (FCR) for the catchment area, increased from 3.2% to 14.9% over the study period.

Conclusions: The hospital volume of pancreatectomies has increased substantially, while complications and postoperative mortality have remained at acceptable levels. Long-term survival and resection rate of PDAC patients showed notable improvement over two decades.

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Series: Journal of gastrointestinal oncology
ISSN: 2078-6891
ISSN-E: 2219-679X
ISSN-L: 2078-6891
Volume: 14
Issue: 1
Pages: 366 - 378
DOI: 10.21037/jgo-22-649
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
Funding: This work was supported by grants from The Finnish Cultural Foundation (to HH), Vieno and Alli Suorsa Healthcare Foundation (to HH), Georg C. and Mary Ehrnrooth Foundation, Finnish State Research Fund (to HH) and Finnish Medical Foundation (to HH).
Copyright information: © Journal of Gastrointestinal Oncology. All rights reserved. This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: