Twenty years of pancreatoduodenectomy at a tertiary low-volume hospital : A nationwide Icelandic study

Abstract

Background: Due to its geographic isolation and limited population, Iceland inherently operates as a low-volume center for pancreatic surgery. To ensure high-quality health care, there is a long tradition of specialists training abroad. This retrospective cohort study aimed to evaluate pancreatic surgery outcomes in Iceland. Methods: Patients who had undergone pancreatoduodenectomy in Iceland between 2003 and 2022 were included and compared between early (2003–2012) and late (2013–2022) periods. Results: During the study period, 244 patients underwent a pancreatic procedure in Iceland, 122 of which were pancreatoduodenectomies. There was a notable increase in resection rates from the early to the late period, accompanied by significant reductions in the rates of pancreatic fistulas, postpancreatectomy hemorrhages, reoperations, length of hospital stay, and 30-day mortality. The rates of ideal outcome (54 %) and 90-day mortality (3 %) in the latter period were comparable to international rates. However, the total resection rates were low for the population size, and histopathological results revealed a high percentage of early-stage tumors. Discussion: The findings of this retrospective study indicate a satisfactory standard of pancreatic surgery over the past decade, suggesting that the existing educational framework is effective. With continued careful preoperative evaluation, more patients could undergo pancreatic surgery in Iceland.