Benchmark in surgical management of pancreatic and biliary tract malignancies

Cameron and colleagues in this article (1) have presented a retrospective review of two thousand consecutive pancreaticoduodenectomies performed by a single surgeon (JC), between March 1969 and March of 2012. This impressive review serves as a benchmark in the management of pancreatic, distal bile duct, periampullary and duodenal cancers, and is a tribute to one surgeon’s determination and drive to improve surgical outcomes with this operation. This article outlines the evolution of pancreaticoduodenectomies as an infrequent, highly morbid operations in the early 1970’s, with hospital mortality rates as high as 25%, to our present state, with 30-day hospital mortality as low as 1.6% in this series. The improvements in outcomes with pancreaticoduodenectomies throughout the world are in a large part is due to the experience acquired by Dr. Cameron performing this operation in a high volume center. Historically, this paper chronicles Dr. Cameron’s experience, and is a window into the early years when this operation began to be performed more frequently. In the first 21 years of this review [1969-1980], only 65 pancreaticoduodenectomies were performed, in contrast, between the year 2000 and 2012, more than 1,300 pancreaticoduodenectomies were performed. It’s hard to imagine the hours spent performing this number of procedures, particularly when you consider the numerous obligations Dr. Cameron had during this period of time.