Completion Pancreatectomy After Pancreatoduodenectomy: Who Needs It?
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 Jul 2023
01 Jul 2023
Historique:
medline:
12
6
2023
pubmed:
6
7
2022
entrez:
5
7
2022
Statut:
ppublish
Résumé
The objective of this study was to identify the indications for and report the outcomes of completion pancreatectomy (CPLP) in the postoperative course after pancreatoduodenectomy (PD). CPLP may be considered or even inevitable for damage control after PD. A prospectively maintained database of all patients undergoing PD between 2001 and 2019 was searched for patients who underwent CPLP in the postoperative course after PD. Baseline characteristics, perioperative details, and outcomes of CPLP patients were analyzed and specific indications for CPLP were identified. A total of 3953 consecutive patients underwent PD during the observation period. CPLP was performed in 120 patients (3%) after a median of 10 days following PD. The main indications for CPLP included postpancreatectomy acute necrotizing pancreatitis [n=47 (39%)] and postoperative pancreatic fistula complicated by hemorrhage [n=41 (34%)] or associated with uncontrollable leakage of the pancreatoenteric anastomosis [n=23 (19%)]. The overall 90-day mortality rate of all 3953 patients was 3.5% and 37% for patients undergoing CPLP. Our finding that only very few patients (3%) need CPLP suggests that conservative, interventional, and organ-preserving surgical measures are the mainstay of complication management after PD. Postpancreatectomy acute necrotizing pancreatitis, uncontrollable postoperative pancreatic fistula, and fistula-associated hemorrhage are highly dangerous and represent the main indications for CPLP after PD.
Sections du résumé
OBJECTIVE
OBJECTIVE
The objective of this study was to identify the indications for and report the outcomes of completion pancreatectomy (CPLP) in the postoperative course after pancreatoduodenectomy (PD).
BACKGROUND
BACKGROUND
CPLP may be considered or even inevitable for damage control after PD.
METHODS
METHODS
A prospectively maintained database of all patients undergoing PD between 2001 and 2019 was searched for patients who underwent CPLP in the postoperative course after PD. Baseline characteristics, perioperative details, and outcomes of CPLP patients were analyzed and specific indications for CPLP were identified.
RESULTS
RESULTS
A total of 3953 consecutive patients underwent PD during the observation period. CPLP was performed in 120 patients (3%) after a median of 10 days following PD. The main indications for CPLP included postpancreatectomy acute necrotizing pancreatitis [n=47 (39%)] and postoperative pancreatic fistula complicated by hemorrhage [n=41 (34%)] or associated with uncontrollable leakage of the pancreatoenteric anastomosis [n=23 (19%)]. The overall 90-day mortality rate of all 3953 patients was 3.5% and 37% for patients undergoing CPLP.
CONCLUSIONS
CONCLUSIONS
Our finding that only very few patients (3%) need CPLP suggests that conservative, interventional, and organ-preserving surgical measures are the mainstay of complication management after PD. Postpancreatectomy acute necrotizing pancreatitis, uncontrollable postoperative pancreatic fistula, and fistula-associated hemorrhage are highly dangerous and represent the main indications for CPLP after PD.
Identifiants
pubmed: 35781509
doi: 10.1097/SLA.0000000000005494
pii: 00000658-202307000-00035
pmc: PMC10249602
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e87-e93Informations de copyright
Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Oba A, Croce C, Hosokawa P, et al. Prognosis based definition of resectability in pancreatic cancer: a road map to new guidelines. Ann Surg. 2022;275:175–181.
Morales-Oyarvide V, Mino-Kenudson M, Ferrone CR, et al. Intraductal papillary mucinous neoplasm of the pancreas in young patients: tumor biology, clinical features, and survival outcomes. J Gastrointest Surg. 2018;22:226–234.
Del Chiaro M, Torphy RJ, Schulick RD. Pancreatic incidentalomas: investigation and management. J Intern Med. 2021;290:969–979.
Jani N, Bani Hani M, Schulick RD, et al. Diagnosis and management of cystic lesions of the pancreas. Diagn Ther Endosc. 2011;2011:478913.
He J, Ahuja N, Makary MA, et al. 2564 resected periampullary adenocarcinomas at a single institution: trends over three decades. HPB (Oxford). 2014;16:83–90.
Mihaljevic AL, Hackert T, Loos M, et al. Not all Whipple procedures are equal: proposal for a classification of pancreatoduodenectomies. Surgery. 2021;169:1456–1462.
Merath K, Mehta R, Tsilimigras DI, et al. In-hospital mortality following pancreatoduodenectomy: a comprehensive analysis. J Gastrointest Surg. 2020;24:1119–1126.
Sánchez-Velázquez P, Muller X, Malleo G, et al. Benchmarks in pancreatic surgery: a novel tool for unbiased outcome comparisons. Ann Surg. 2019;270:211–218.
Van Rijssen LB, Koerkamp BG, Zwart MJ, et al. Nationwide prospective audit of pancreatic surgery: design, accuracy, and outcomes of the Dutch Pancreatic Cancer Audit. HPB (Oxford). 2017;19:919–926.
Bassi C, Marchegiani G, Giuliani T, et al. Pancreatoduodenectomy at the verona pancreas institute: the evolution of indications, surgical techniques and outcomes: a retrospective analysis of 3000 consecutive cases. Ann Surg. 2022;276:1029–1038.
Ecker BL, McMillan MT, Asbun HJ, et al. Characterization and optimal management of high-risk pancreatic anastomoses during pancreatoduodenectomy. Ann Surg. 2018;267:608–616.
McMillan MT, Allegrini V, Asbun HJ, et al. Incorporation of procedure-specific risk into the ACS-NSQIP surgical risk calculator improves the prediction of morbidity and mortality after pancreatoduodenectomy. Ann Surg. 2017;265:978–986.
Standop J, Glowka T, Schmitz V, et al. Operative re-intervention following pancreatic head resection: indications and outcome. J Gastrointest Surg. 2009;13:1503–1509.
Bannone E, Andrianello S, Marchegiani G, et al. Postoperative acute pancreatitis following pancreaticoduodenectomy: a determinant of fistula potentially driven by the intraoperative fluid management. Ann Surg. 2018;268:815–822.
De Castro SM, Busch OR, van Gulik TM, et al. Incidence and management of pancreatic leakage after pancreatoduodenectomy. Br J Surg. 2005;92:1117–1123.
Balzano G, Pecorelli N, Piemonti L, et al. Relaparotomy for a pancreatic fistula after a pancreaticoduodenectomy: a comparison of different surgical strategies. HPB (Oxford). 2014;16:40–45.
Farvacque G, Guilbaud T, Loundou AD, et al. Delayed post-pancreatectomy hemorrhage and bleeding recurrence after percutaneous endovascular treatment: risk factors from a bi-centric study of 307 consecutive patients. Langenbecks Arch Surg. 2021;406:1893–1902.
Marchegiani G, Barreto SG, Bannone E, et al. International Study Group for Pancreatic Surgery. Postpancreatectomy acute pancreatitis (PPAP): definition and grading from the International Study Group for Pancreatic Surgery (ISGPS). Ann Surg. 2022;275:663–672.
Hank T, Sandini M, Ferrone CR, et al. Association between pancreatic fistula and long-term survival in the era of neoadjuvant chemotherapy. JAMA Surg. 2019;154:943–951.
Bassi C, Falconi M, Salvia R, et al. Management of complications after pancreaticoduodenectomy in a high volume centre: results on 150 consecutive patients. Dig Surg. 2001;18:453–457.
Sohn TA, Yeo CJ, Cameron JL, et al. Pancreaticoduodenectomy: role of interventional radiologists in managing patients and complications. J Gastrointest Surg. 2003;7:209–219.
Jürgensen C, Distler M, Arlt A, et al. EUS-guided drainage in the management of postoperative pancreatic leaks and fistulas (with video). Gastrointest Endosc. 2019;89:311.e1–319.e1.
Stampfl U, Hackert T, Sommer CM, et al. Superselective embolization for the management of postpancreatectomy hemorrhage: a single-center experience in 25 patients. J Vasc Interv Radiol. 2012;23:504–510.
Smits FJ, van Santvoort HC, Besselink MG, et al. Management of severe pancreatic fistula after pancreatoduodenectomy. JAMA Surg. 2017;152:540–548.
Bouras AF, Marin H, Bouzid C, et al. Pancreas-preserving management in reinterventions for severe pancreatic fistula after pancreatoduodenectomy: a systematic review. Langenbecks Arch Surg. 2016;401:141–149.
Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142:20–25.
Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. International Study Group on Pancreatic Fistula Definition. Surgery. 2005;138:8–13.
Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. International Study Group on Pancreatic Surgery (ISGPS). Surgery. 2017;161:584–591.
Nentwich MF, El Gammal AT, Lemcke T, et al. Salvage completion pancreatectomies as damage control for post-pancreatic surgery complications: a single-center retrospective analysis. World J Surg. 2015;39:1550–1556.
Farley DR, Schwall G, Trede M. Completion pancreatectomy for surgical complications after pancreaticoduodenectomy. Br J Surg. 1996;83:176–179.
Tamijmarane A, Ahmed I, Bhati CS, et al. Role of completion pancreatectomy as a damage control option for post-pancreatic surgical complications. Dig Surg. 2006;23:229–234.
Gueroult S, Parc Y, Duron F, et al. Completion pancreatectomy for postoperative peritonitis after pancreaticoduodenectomy: early and late outcome. Arch Surg. 2004;139:16–19.
Groen JV, Smits FJ, Koole D, et al. Completion pancreatectomy or a pancreas-preserving procedure during relaparotomy for pancreatic fistula after pancreatoduodenectomy: a multicentre cohort study and meta-analysis. Br J Surg. 2021;108:1371–1379.
Connor S. Defining post-operative pancreatitis as a new pancreatic specific complication following pancreatic resection. HPB (Oxford). 2016;18:642–651.
Globke B, Timmermann L, Klein F, et al. Postoperative acute necrotizing pancreatitis of the pancreatic remnant (POANP): a new definition of severe pancreatitis following pancreaticoduodenectomy. HPB (Oxford). 2020;22:445–451.
Loos M, Strobel O, Dietrich M, et al. Hyperamylasemia and acute pancreatitis after pancreatoduodenectomy: two different entities. Surgery. 2021;169:369–376.