ABSTRACT
BACKGROUND: Although mortality post-pancreaticoduodenectomy (PD) has decreased, morbidity rates continue to be high, ranging from 30% to 50%. Among complications, hemorrhage stands out; it is associated with high mortality and there is no standard management. The aim of the present study was to analyze the incidence, diagnosis, and treatment of hemorrhage post-cephalic PD at our center. METHODS: From January 2005 to December 2008, 107 PDs were performed. A retrospective review of characteristics of patients with postoperative hemorrhage was made from our prospective database. Demographic data, diagnosis, treatment (medical, laparotomy, interventional radiology), association with fistula (pancreatic or biliary), intra- or extraluminal hemorrhage, bleeding time (early or late), severity (moderate/severe), and mortality were analyzed. RESULTS: Eighteen patients (18/107; 16.82%) hemorrhaged after PD. Hemorrhage appeared early (< 24 h) in 4 of these 18 patients (22.2%), and it was severe in 13/18 (72%). Hemorrhage-related mortality was 11% (2/18) and hospital mortality was 22.2% (4/18). Arteriography was performed in 8/18 patients (44.4%) and was effective in 6/8 (75%); laparotomy was performed in 8/18 (44.4%). Re-bleeding occurred in 5 of these 18 patients after the first treatment (27.8%). An association between hemorrhage and fistula was observed. CONCLUSIONS: Hemorrhage after pancreatic resection must be considered a complication with relatively high mortality. Diagnosis should be established and treatment applied rapidly. Pancreatic and/or biliary fistulae were significantly associated with a higher risk of postoperative hemorrhage. Interventional radiology is a good therapeutic option.
Subject(s)
Pancreaticoduodenectomy , Postoperative Hemorrhage , Aged , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Postoperative Hemorrhage/diagnosis , Postoperative Hemorrhage/epidemiology , Postoperative Hemorrhage/therapy , Prognosis , Recurrence , Retrospective Studies , Risk FactorsABSTRACT
INTRODUCTION: Results of surgical treatment for pancreatic and periampullary carcinoma have improved in recent years owing to several factors, particularly the concentration of these patients in specialised surgical units. MATERIAL AND METHODS: Retrospective-prospective comparative study of results in 2 groups of patients treated over 2 different periods of time and with different surgical policy: group A, which included 80 patients treated from 1982 to 1992 in a general surgery unit, and group B, which comprised 151 patients treated from 1998 to 2003 in a specialised hepato-biliary-pancreatic surgery unit. RESULTS: Surgical treatment in patients of groups A and B, respectively, was: resection in 20% and 53.6% and by-pass in 62.5% and 36.4%. Postoperative morbidity after resection was similar (75% vs 74.1%) but higher after by-pass in group B (41.8% vs 34%). Postoperative mortality after surgical resection and by-pass was 25% and 14.1%, respectively, for group A and 3.7% and 16.3%, respectively, for group B. Mean survival for all patients was 7.0 +/- 7.1 months for group A and 14.1 +/- 15.3 months for group B. Mean survival for patients with surgical resection was 11.8 +/- 9.8 months and 18.7 +/- 15.8 months for groups A and B, respectively. CONCLUSIONS: Pancreatic and periampullary carcinoma should be surgically treated in specialised pancreatic surgery units in order to offer the best outcome to patients.
Subject(s)
Ampulla of Vater , Common Bile Duct Neoplasms/surgery , Pancreatic Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Digestive System Surgical Procedures , Female , Humans , Male , Middle Aged , Survival AnalysisABSTRACT
Introducción: Los resultados de la cirugía de la neoplasia de páncreas y región periampular han mejorado en los últimos años por diversos motivos, entre los que destaca el tratamiento de esta enfermedad en unidades especializadas. Material y métodos: Estudio retrospectivo-prospectivo de 2 grupos de pacientes tratados en períodos y contextos de unidades de cirugía distintos: grupo A (80 pacientes), tratado entre 1982 y 1992 en un servicio de cirugía general, y grupo B (151 pacientes), tratado entre 1998 y 2003 en una unidad de cirugía hepatobiliopancreática. Resultados: La resección se realizó en el 20 y el 53,6% de los pacientes y la derivación, en el 62,5 y el 36,4% de los pacientes de los grupos A y B, respectivamente. Las complicaciones postoperatorias fueron similares después de la resección (el 75 frente al 74,1%) y más elevadas después de la derivación en el grupo B (el 41,8 frente al 34%). La mortalidad postoperatoria fue del 25 y el 3,7% después de la resección, y del 14,1 y el 16,3% después de la derivación, respectivamente, para los grupos A y B. La supervivencia global media (± desviación estándar) fue de 7,0 ± 7,1 y de 14,1 ± 15,3 meses para los grupos A y B, respectivamente, y la supervivencia después de la resección, de 11,8 ± 9,8 y de 18,7 ± 15,8 meses. Conclusiones: La cirugía de la neoplasia de la región pancreática debería realizarse en unidades quirúrgicas especializadas para ofrecer a los pacientes los mejores resultados
Introduction: Results of surgical treatment for pancreatic and periampullary carcinoma have improved in recent years owing to several factors, particularly the concentration of these patients in specialised surgical units. Material and methods: Retrospective-prospective comparative study of results in 2 groups of patients treated over 2 different periods of time and with different surgical policy: group A, which included 80 patients treated from 1982 to 1992 in a general surgery unit, and group B, which comprised 151 patients treated from 1998 to 2003 in a specialised hepato-biliary-pancreatic surgery unit. Results: Surgical treatment in patients of groups A and B, respectively, was: resection in 20% and 53.6% and by-pass in 62.5% and 36.4%. Postoperative morbidity after resection was similar (75% vs 74.1%) but higher after by-pass in group B (41.8% vs 34%). Postoperative mortality after surgical resection and by-pass was 25% and 14.1%, respectively, for group A and 3.7% and 16.3%, respectively, for group B. Mean survival for all patients was 7.0 ± 7.1 months for group A and 14.1 ± 15.3 months for group B. Mean survival for patients with surgical resection was 11.8 ± 9.8 months and 18.7 ± 15.8 months for groups A and B, respectively. Conclusions: Pancreatic and periampullary carcinoma should be surgically treated in specialised pancreatic surgery units in order to offer the best outcome to patients
