TH2.8 Continuing fast-track (Expedited) pancreaticoduodenectomy service during the Covid-19 pandemic: Experience from an established pancreatic surgical centre

Abstract

Aim Avoiding preoperative biliary drainage (PBD) can facilitate early curative surgery for patients with periampullary tumours. However, the evidence over PBD is conflicting. This prospective re-audit aimed to assess compliance to NICE guidelines (NG85) and surgical outcomes at a well-established HPB surgery unit after achieving additional theatre sessions following prior audit.

Methods Prospective data collection and analysis for all patients undergoing pancreaticoduodenectomy with curative intent was performed as re-audit at a tertiary pancreatic centre between September 2020 to August 2021.

Results 64 or 71 patients received curative pancreaticoduodenectomy (43 Kausch-Whipple & 23 pylorus-preserving pancreaticoduodenectomy, 7 inoperable). Of 29 patients without PBD, 10 were jaundiced with median bilirubin levels of 138 Micromole/L (range 27–357 Mmol/L). Median time (range) from diagnostic imaging to surgery with curative intent was 21 days (3–42) for patients without PBD compared to 62 days (22–305) for those with PBD (p=0.00028). No statistically significant difference in median HDU/ITU stay (4 Vs 3 days, p=0.849), postoperative complications (C-D>2) (30% Vs 27.8%, p=0.755), R0 resection rates (42.8% Vs 75%, p=0.364), and median hospital stay (17 Vs 10 days, p=0.076) was observed for patients without or with PBD respectively. Interestingly, inoperable patients had shorter time delay from diagnostic imaging to surgery (29 Vs 49 days, p=0.010)

Conclusion Fast-track (expedited) pancreaticoduodenectomy is feasible and safe for selected group of jaundiced patients without PBD. The constraints and challenges posed by Covid-19 pandemic are likely reflected in higher number of patients receiving PBD (42/ 71) despite clear referral pathway established following prior work at our institute.