Whipple’s operation with a modified centralization concept:A model in low-volume Caribbean centers  

作　　者：Shamir O Cawich Neil W Pearce Vijay Naraynsingh Parul Shukla Rahul R Deshpande 

机构地区：[1]Department of Clinical Surgical Sciences,University of the West Indies,St Augustine 000000,Trinidad and Tobago [2]University Surgical Unit,Southampton General Hospital,Southampton SO166YD,United Kingdom [3]Department of Surgery,Weill Cornell Medical College,New York,NY 10065,United States [4]Department of Surgery,Manchester Royal Infirmary,Manchester M139WL,United Kingdom

出　　处：《World Journal of Clinical Cases》2022年第22期7620-7630,共11页世界临床病例杂志

摘　　要：Conventional data suggest that complex operations,such as a pancreaticoduodenectomy(PD),should be limited to high volume centers.However,this is not practical in small,resource-poor countries in the Caribbean.In these settings,patients have no option but to have their PDs performed locally at low volumes,occasionally by general surgeons.In this paper,we review the evolution of the concept of the high-volume center and discuss the feasibility of applying this concept to low and middle-income nations.Specifically,we discuss a modification of this concept that may be considered when incorporating PD into low-volume and resource-poor countries,such as those in the Caribbean.This paper has two parts.First,we performed a literature review evaluating studies published on outcomes after PD in high volume centers.The data in the Caribbean is then examined and we discuss the incorporation of this operation into resource-poor hospitals with modifications of the centralization concept.In the authors’opinions,most patients who require PD in the Caribbean do not have realistic opportunities to have surgery in high-volume centers in developed countries.In these settings,their only options are to have their operations in the resource-poor,low-volume settings in the Caribbean.However,post-operative outcomes may be improved,despite low-volumes,if a modified centralization concept is encouraged.

关 键 词：PANCREAS SURGERY PANCREATECTOMY Whipple’s PANCREATICODUODENECTOMY 

分 类 号：R197.1[医药卫生—卫生事业管理]