2.3. Patients

All patients underwent preoperative staging by diagnostic imaging, which included a triple-phase multidetector-row computed tomography and if needed supplementary magnetic resonance imaging, endoscopic ultrasonography, and positron emission tomography. All images were evaluated and thoroughly discussed with assessment of resectability at our multidisciplinary tumor conference in the presence of surgeons, oncologists, and dedicated radiologists.

Before operation, a pancreatic surgeon and an anesthesiologist evaluated the patient's operability in the out-patient clinic, and a dedicated counseling providing the patient with information and goals for recovery was given. Preoperative optimization of organ dysfunction was performed, and all patients with heart disease, earlier heart surgery or 80 years and older underwent preoperative cardiologic examination including echocardiography and, if necessary, interventional coronary angiography. Patients with pulmonary disease had pulmonary function test and echocardiography. Stenting of the biliary duct by endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) was performed in patients with jaundice if operation could not be performed in less than one week or if serum bilirubin exceeded 100 μmol/L to avoid renal toxicity. No patients had a WHO performance score exceeding 2.