Risk Factors Of Severe Complications And The Death After Pancreaticoduodenectomy

Objective:Pancreaticoduodenectomy(PD)remains to be the only curative treatment for the carcinoma of pancreatic head and periampullary carcinoma,but there are more complications and death happened after PD,because of resections of more organs and complicated reconstruction,For every surgeon,it is a great challenge. As severe complications with high morbidity,anastomotic fistula, intraabdominal abscess and postoperative hemorrhage,which threaten patients' lives,are leading causes of death after PD.Currently,it still remains very controversial as regard to risk factors for severe complications and mortality.The aim of this study was to evaluate these risk factors by retrospectively analysing medical records of 137 patients undergone PD,so as to provide a few help for raising the safety of surgery。Material and methods:137 patients underwent PD at the 2nd Xiangya hospitol from Jan,2003 to Dec.2007.Amongst which,there are 95 male patients(69.8%),42 female patients(30.2%),aging from 25 years old to 78 years old(54.69±11.54).Data was collected and categorized as clinic factors,lab factors, surgery factors,pathologic factor and operative complications.Data statistics are processed by SPSS 11.0 software.The results from single variable analysis are validated by chi-square test and Fisher Exact Probability.We then selected factors with P values less than 0.10 for inclusion as factors in the mutivariate analysis using stepwise logistic regression,we use step-by-step Logistic Regression for multiple variable analysis.The factors that are kept in the Logistic regression model as defined as significant and dangerous ones which are independent as well.Results:There is no complication occurred in 72 patients(51.1%), The rest 65 patients(48.9%),experienced complications for 148 times (table 3);Amongst which,the incidences of pancreatic fistula,biliary fistula,celiac infection and postoperative hemorrhage are respectively 8.8%,9.4%,11.4%and 12.8%.The death rate within 30 days of operation is 6.7%.The risk factors for pancreatic fistula include previous surgery on upper abdomen(OR=6.741),pre-operative TIBL≥171μmol/L (OR=3.308),soft texture of the pancreas(OR=3.556)and pancreatic duct diameter＜3mm(OR=6.106).The predictive formula for pancreatic fistula is:P=1/[1+e^{-(-5.646+1.908 previous surgery on upper abdomen+1.196 pre-operative TIBL≥171μmol/L+1.269 texture of the pancreas+1.809 pancreatic duct diameter)}]; The risk factors for biliary fistula include bile duct diameter＜1.5cm (OR=11.646),intraoperactive blood-loss≥800ml(OR=4.519), post-operative albumin＜30g/L(OR=3.938).The predictive formula for biliary fistula is:P=[1+e^{-(-4.144+2.455 bile duct diameter+1.708 intraoperactive blood-loss+1.371post-operative albumin)}],The risk factors for celiac infection Include intraoperactive blood-loss≥800ml(OR=4.735)and the post-operative anastomotic leakage(OR=5.447).The predictive formula for celiac infection is:P=[1+e^{-(-2.845+1.555 intraoperactive blood-loss+2.026 anastomotic leakage)}];The dangerous factors for postoperative hemorrhage include:postoperative Hb＜90g/L(OR=4.880),soft texture of the pancreas(OR=5.026),intraoperative transfusion≥1000ml(OR=8.578). The predictive formula for postoperative hemorrhage is:P=[1+e^{-(-3.939 +1.585 post-operative Hb+1.615 texture of the pancreas+2.149 intraoperative transfusion)}]. The dangerous factors for operative death include:postoperative hemorrhage(OR=30.089),pre-operative albumin＜30g/L(OR=16.630), intraoperactive blood-loss≥800ml(OR=6.548).The predictive formula is:P=[1+e^{-(-5.260+3.404 postoperative hemorrhage+2.811 pre-operative albumin+1.879 intraoperactive blood-loss)}].Conclusion:pre-operative TIBL≥171μmol/L,previous surgery on upper abdomen,undilated pancreatic duct and the soft texture of the pancreas predipose the high probability of pancreatic fistula.;The main risk factors for biliary fistula include intraoperactive blood-loss≥800ml, bile duct diameter＜1.5cm and post-operative albumin＜30g/L;The celiac infection usually happens on the patients who have intraoperactive blood-loss≥800ml and post-operative anastomotic leakage;The dangerous factors for postoperative hemorrhage include soft texture of the pancreas,Post-operative Hb＜90g/L and the great blood-loss of surgery;The postoperative hemorrhage,pre-operative albumin＜30g/L, blood-loss of surgery≥800ml can be defined as risk factors for postoperative death after PD.