Complications After Pancreatectomy In A Single-center Study Of1311Consecutive Resections In25Years

Objective: To summarize and analyze the clinical features of complications afterpancreatic resection, analysis of the risk factors of postoperative complications.Methods: A retrospective review was performed of the medical records of1311patients who underwent pancreatectomy in Chinese PLA General Hospital (Beijing,China) between June1986and December2010. The diagnoses of disease were fromthe postoperative pathological results.Results:1. The major complications after pancreaticoduodenectomy were pancreaticfistula (19.5%), delayed gastric emptying (17.5%), post-operative hemorrhage (9.1%),abdominal infection (4.7%), biliary fistula (5.1%) and wound related complications(6.8%). The independent risk factors for post-PD complications were pancreatic ductdiameter, operation time, and the post-operative days of reestablishment of naturalnutrition; The independent risk factors for postoperative death in hospital was the ageof patient. The major complications after distal pancreatic resection (DP) werepancreatic fistula (20.4%), delayed gastric emptying (7.1%), infection of incisionalwound(2.9%); The independent risk factors for post-DP complications were operationduration and primary tumor site; It was to be found that no independent risk factorsfor post-DP death during hospitalization. The number of middle pancreatectomy,duodenum preserving pancreatic head resection and pancreatic tumor localenucleation were fewer in our center, and the major complication of these procedureswas pancreatic fistula (33.4%,20%and26.3%, respectively).2. Pancreatic ductdiameter and the POD time of reestablishment of liquid food were significantcorrelated with postoperative pancreatic fistula. The amylase activity of the abdominaldrainage at1-7post-operative days was not associated with the postoperativepancreatic fistula. Operation time is the risk factor for PPH in patients with pancreatic fistula; male as well as the patients’ age were risk factors for relaparotomy in patientswith pancreatic fistula; the patients’ age is the risk factor for in-hospital death inpatients with pancreatic fistula. The amylase activity of the abdominal drainage at1,4and7post-operative days was not associated with bleeding, relaparotomy andin-hospital death.3. Male gender, end-to-side invagination pancreaticojejunostomy,preoperative serum total bilirubin level>171μmol/L, pancreatic fistula andintraabdominal abscess are independent risk factors for PPH. Urgent relaparatomy forearly PPH and angiography for late extraluminal PPH are good therapeutic option.More attention should to be paid to sentinel bleeding. Active prevention of rebleedingafter successful haemostasis plays an important role of improving the prognosis ofpost-PD hemorrhage.Conclusion: Pancratectomy can be performed safely with low morbidity, providedthat it is carried out with optimal perioperative management and improvement ofoperative technology of pancreatic resection. Emphasis on prevention of pancreaticfistula and active management of severe pancreatic fistula and post-operativehemorrhage were the main measures to reduce postoperative mortality.