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Surgery Today

, Volume 45, Issue 2, pp 181–188 | Cite as

Perioperative management for pancreatoduodenectomy following severe acute pancreatitis in patients with periampullary cancer: our experience with six consecutive cases

  • Sadaki AsariEmail author
  • Ippei Matsumoto
  • Tetsuo Ajiki
  • Makoto Shinzeki
  • Tadahiro Goto
  • Takumi Fukumoto
  • Yonson Ku
Original Article

Abstract

Purpose

We rarely have an opportunity to perform pancreatoduodenectomy (PD) following the onset of severe acute pancreatitis (SAP) for patients with periampullary cancer. The perioperative risks and optimal timing of subsequent PD have, therefore, remained unclear.

Methods

Between January 2006 and December 2012, we performed PD in six patients with SAP. We reviewed these six cases, and compared the perioperative risks of morbidity and mortality with those of 81 concurrent PD patients matched for primary cancer without preoperative SAP.

Results

The six patients were classified as having SAP based on the Japanese criteria developed in 2008. The SAP in five patients was caused by ERCP procedures. The median interval from SAP onset to the operation was 111 days. The rate of Grade B/C postoperative pancreatic fistula formation in the SAP patients was significantly higher than that of the 81 control patients (83 vs. 26 %, P < 0.001). In addition, the median postoperative hospital stay was significantly longer in the six SAP patients relative to that of the control patients (40 vs. 30 days, P < 0.001).

Conclusions

An interval of at least 3 months after surgery may be needed to decrease the inflammation of the peripancreas region after SAP. Therefore, unnecessary and low-yield ERCP procedures should be avoided in these patients.

Keywords

Severe acute pancreatitis Pancreatoduodenectomy ERCP 

Abbreviations

Alb

Albumin

Amy

Amylase

AP

Acute pancreatitis

CRP

C-reactive protein

CT

Computed tomography

ERCP

Endoscopic retrograde cholangiopancreatography

EUS

Endoscopic ultrasonography

GEM

Gemcitabine

IPMN

Intraductal papillary mucinous neoplasm

MRCP

Magnetic resonance cholangiopancreatography

PD

Pancreatoduodenectomy

PPPD

Pylorus-preserving pancreatoduodenectomy

PEP

Severe post-ERCP pancreatitis

POPF

Postoperative pancreatic fistula

RT

Radiation therapy

SAP

Severe acute pancreatitis

SSPPD

Subtotal stomach-preserving pancreatoduodenectomy

TP

Total pancreatectomy

Notes

Conflict of interest

The authors declare that they have no conflicts of interest.

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Copyright information

© Springer Japan 2014

Authors and Affiliations

  • Sadaki Asari
    • 1
    Email author
  • Ippei Matsumoto
    • 1
  • Tetsuo Ajiki
    • 1
  • Makoto Shinzeki
    • 1
  • Tadahiro Goto
    • 1
  • Takumi Fukumoto
    • 1
  • Yonson Ku
    • 1
  1. 1.Division of Hepato-Biliary-Pancreatic Surgery, Department of SurgeryKobe University Graduate School of MedicineKobeJapan

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