Risk Factors Of Severe Complications After Pancreaticodudenectomy

Objective: To investigate the influencing factors of severe complications after pancreaticodudenectomy (PD).Methods: From January 1997 to December 2003,182 patients who underwent PD consecutively at Sir Run Run Shaw hospital were reviewed retrospectively. Severe complications included pancreatic fistula(PF), bile fistula, anastomotic fistula, anastomotic stenosis, abdominal or gastrointestinal hemorrhage, MODF, intra-abdominal infections, gastroparalysis. Pneumonia, wound infection, wound dehiscence, pleural effusion were diagnosed as general complications. Sixteen factors which potentially affect the incidence of the complication were analyzed with univariate and multivariate logistic regression model.Results:1. Of the 182 patients, the incidence rate of overall complication and death were 34.1% (62/182) and 3.3% respectively, 28 cases had severe complication and 6 cases died in the group (15.4%), 34 cases had general complication and nobody died in the group.2. Compared by group of general complications or group of no complication, the group of severe complications' hospitalization time was prolong (33.63 ±7.47, 16.16 ± 1.20, 17.32 ± 4.66, P<0.05), the occurrence of company generalpostoperative complications was significantly higher (x~2=7.6 P<0.01).3. In univariate analysis, it seems that four main factors were correlated with the occurrence of severe postoperative complications: soft texture of the remnant pancreas, a small pancreatic duct size, massive intra-operative blood loss, pancreaticojejunosotomy. Multivariate logistic regression analysis revealed that intra-operative blood loss over 1000ml and invaginated pancreaticojejunosotomy were independent complication risk factors (OR=9.95 and OR=5.28).Conclusions: Binding pancreaticojejunostomy and good operative technique can reduced the incidence of severe complication after PD effectively.