Introduction : To evaluate clinicopathological features and chronologic changes of postoperative outcomes in patients undergoing pancreaticoduodenectomy (PD).

Methods : We retrospectively reviewed 2,668 cases of PD performed at Samsung Medical Center in Seoul, Korea for 14 years from January 2005 to December 2018. To identify clinicopathologic features, periampullary diseases were classified into 4 locations of pancreas, bile duct, ampulla and duodenum. The chronologic changes in postoperative outcomes were compared between subdivided periods of 1st period (between 2005 and 2011) and 2nd period (between 2012 and 2018). In order to obtain at least 2 years of follow-up data for survival analysis, 2nd period was set between 2012 and 2016.

Results : 1,098 and 1,570 cases were performed in 1st and 2nd periods, respectively. Most of PD were performed on diseases of pancreas, followed by bile duct, ampulla, and duodenum. Benign cases accounted for about 15% of entire cases. When analyzing chronologic changes of postoperative outcomes in entire cases, we identified complication rate was significantly lower, and hospital stay was significantly shorter in 2nd period. The postoperative pancreatic fistula did not significantly differ between two period groups. In survival analysis of cancers of each location, survival rates were significantly higher in 2nd period than in 1st period.

Conclusions : PD has been increasingly being performed to more patients. It was confirmed the incidence of postoperative complications was reduced and survival was improved in our study. Although we cannot conclude PD is sole factor in improving survival, development of PD will lead to therapeutic improvement in periampullary diseases.