Ralated Factors Of Major Complications After Pancreaticoduodenectomy

Despite being a complex and technically demanding operation, pancreaticoduodenectomy (PD) is still established as the best choice in the treatment of cancer of the head of the pancreas and periampullary region. The mortality associated with the operation have dramatically reduced over the years due to the recent advances in operative technique and postoperative patient management. But its morbidity still remains high. Now how to prevent and treat these postoperative complications become the linchpin of our surgery. To further understand the risk factors contributing to these complications, we conducted a retrospective review of patients underwent PD in order to give advice to surgery.Cases and MethodsPatients who underwent PD at the Sir Run Run Shaw Hospital between December2003 and January 2001 (Medcial College of Zhejiang University) were enrolled. Patients were excluded when they had palliative resection. We conducted a retrospective review of these patients. All the postoperative complications(including pancreatic leakge, bile leakge, intestinal leakge, hemorrhage, infection, delayed gastric emptying, stenosis of anastomosis) were ascertained by recordation of cases. Putative risk factors for the development of postoperative complications were conceptually divided into three broad categories: (l)patient-related factors, such as age, gender, the total bilirubin and albumin level of serum, and the history of abdominal surgery;(2) surgeon-related factors, such as operative time, estimated blood loss, intraoperative blood transfusions, pancreatic anastomotic technique, and (3) disease-related factors, such as the size, character, margins, total and positive lymph nodes, pathology of each specimen were recorded. Statistics were computed with the SPSS-vl2.0 software suite to compare the relationship between postoperative complications and putative risk factors.ResultsOf the 102 patients undergoing pancreaticoduodenectomy at the Sir Run Run Shaw Hospital, data regarding the absence of postoperative complications were available for 101 patients who were considered in further analyses. Overall operative mortality was 2.9%(3/101), and major morbidity wasl6.8%(17/101,including hemorrhage 4, abdominal infection 4, bile leakge 4, stenosis of anastomosis 4, delayedgastric emptying 2, pancreatic leafcge 1, intestinal leakge 1). In univariate analysis, the postoperative complications rate was a highly significant correlation (P<0.05) with operative reconstruction procedures (pancreatic-enteric anastomosis), operative time, intraoperative blood loss, intraoperative blood transfusions, margins and pathology of the specimen, and the estimated blood loss was the undepandent risk factor of postoperative complications. In a multivariate model, however, only intraoperative blood loss were statistically predictive.ConclusionsPancreaticoduodenectomy was still a complex and technically demanding operation, its postoperative complications rate was significant correlation with operative course. We should seclect the right operative reconstruction and improve the operative technique to prevent the postoperative complications.