Specialised care in patients undergoing pancreatoduodenectomy

This thesis studies the controversies in the management of patients with pancreatic cancer undergoing pancreatoduodenectomy and determines different factors that will improve this management and thereby the postoperative outcomes. The studies were performed in both the pre-, peri- and postoperative phase. The improvement of preoperative care is analysed by studying the impact of preoperative biliary drainage (PBD) by using metal stents instead of plastic stents, whether the type of stent influenced the complication rate and subsequently the patient’s recovery. Perioperatively, oncological factors, that influence long-term results after surgery, are established and the importance of these factors during tumour staging and the impact on a patient’s prognosis are determined. The postoperative care given at the Academic Medical Centre in Amsterdam (AMC) is analysed and based on those results an algorithm to which type of intervention is appropriate in the management of major postpancreatectomy complications is drafted. This thesis can serve as a guide towards evidence based, best practice management of surgical patients with pancreatic cancer.