Outcomes of pancreaticoduodenectomy from a single oncology center with an emphasis on standardized surgical technique

BACKGROUND Pancreaticoduodenectomy (PD) remains one of the most complex abdominal operations, associated with morbidity rates up to 50%.When performed at high-volume specialized centers, 30-day mortality should fall below 5%. AIMTo present the surgical and oncological outcomes of 512 consecutive patients undergoing PD in a single oncological surgical unit over a 20-year period, and to compare outcomes between two consecutive decades ( 2005-2014 vs 2015-2025).METHODS A retrospective review of a prospectively collected database was conducted on 512 consecutive patients undergoing PD between 2005 and 2025 at the Surgical Oncology Unit of Agios Savvas Oncology Hospital, Athens.Pre-, intra-, and postoperative data were analyzed, including patient demographics, operative details, morbidity, mortality, and pathology results.Temporal comparison was performed between two time periods: 2005-2014 and 2015-2025. RESULTSMean patient age was 66 years (range 26-87).Male patients constituted 55.7% of the cohort.The predominant indication was pancreatic head adenocarcinoma (78.1%).R0 resection was achieved in 74% of cases.Mean operative time was 240 minutes and mean hospital stay was 8 days.Overall morbidity was 35.9%, with clinically relevant postoperative pancreatic fistula (grade B/C) occurring in 17% and delayed gastric emptying in 19.5%.Sixty-day mortality was 2.9%.Comparison between periods revealed 4 / 20 significantly increased lymph node yield (13.7 vs 15.8, P < 0.001) and morbidity (29.7% vs 39.4%, P = 0.028), while mortality remained stable (3.2% vs 2.75%, P = 0.75). CONCLUSIONWithin the limits of an observational, single-arm design, these outcomes are consistent with the proposition that a dedicated, consistent surgical team applying a standardized operative technique at adequate procedural volume can achieve acceptable perioperative outcomes; they should be interpreted as an association rather than as proof of a causal effect of standardization.