Salvage Completion Pancreatectomies as Damage Control for Post-pancreatic Surgery Complications: A Single-Center Retrospective Analysis
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Post-pancreatic surgical morbidity is frequent but often manageable by less invasive means than re-operation. Yet, some complications can become hazardous and life threatening. Herein, the results of a completion pancreatectomy (CP) to cope with severe post-operative pancreatic fistulas (POPF) and bleeding complications after major pancreatic resections for suspected pancreatic malignancy are presented.
CPs to treat severe post-pancreatic index-surgery complications between January 2002 and January 2012 were selected out of a prospective database. Indications for CP as well as perioperative data were prospectively collected and retrospectively assessed.
In 20 of 521 Kausch–Whipple Resections (3.8 %), a CP was necessary to treat post-index surgery morbidity. Indications included insufficiency of the pancreaticojejunal anastomosis with resulting POPF in 14 (70.0 %) patients, severe bleeding complications in 6 (30.0 %) patients, and a severe portal vein thrombosis in 1 (5.0 %) patient. In 7 (35.0 %) of the 20 patients, the course was complicated by remnant pancreatitis. Eleven (55.0 %) of the 20 patients died during the hospital stay. Median time to re-operation did not significantly differ between survivors and in-hospital deaths (10.0 vs. 8.0 days; p = 0.732). Median hospital stay of the surviving patients was 31.0 (range 10–113) days. Re-operations following CPs were necessary in 5 (55.6 %) of the 9 patients who survived and in 9 (81.8 %) out of 11 patients who died.
Post-pancreatic resection complications can become hazardous and result in severely ill patients requiring maximum therapy. CP in these cases has a high mortality but serves as an ultima ratio to cope with deleterious complications.
KeywordsPancreatic Fistula Pancreatic Resection Pancreatic Remnant Pancreatic Anastomosis Anastomotic Insufficiency
Conflict of interest
The authors deny any potential or real conflicts of interest.
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