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Emergency pancreaticoduodenectomy for non-traumatic indications—a systematic review

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Abstract

Purpose

Emergency pancreaticoduodenectomy (EPD) is an uncommon surgical procedure; usually, it is performed in traumatic cases, with non-traumatic indications being very rare. Our review aimed to offer a comprehensive descriptive overview of the characteristics of EPD in non-traumatic settings.

Methods

Our study is a review of individual participant data. PubMed, Cochrane, Google Scholar and Embase databases were searched. The last search was conducted in March 2022; studies that reported EPD for non-traumatic indications were included in the analysis.

Results

Twenty-six articles were identified, twenty-five providing individual participant data; 17 articles (68%) were case reports. One article was a large retrospective study on the NSQIP (American College of Surgeons National Surgical Quality Improvement) database, which enrolled 409 patients that underwent EPD for malignant causes. From the other studies, we extracted individual participant data for a total of 66 patients. The patients were divided in subgroups, based on the indication for surgery: malignant causes (39.39%), uncontrollable bleeding (19.69%), iatrogenic injuries (30.3%), perforations (4.54%), or ischemic causes (6.06%). The postoperative morbidity was higher for the perforation subgroup. Postoperative pancreatic fistula is the most common complication reported (21.21%); higher rates were reported in the malignant and bleeding subgroups, with no special mention of this complication in the NSQIP database study. Mortality rate was 10.3% in the NSQIP database and higher, 19.69% in the 66-patient cohort; the highest mortality rates were registered in the perforation and ischemic subgroup.

Conclusion

EPD is a complex surgical intervention, with important associated morbidity and mortality rates, higher than that in elective settings, although it can be a life-saving procedure in selected cases and should be performed only in high-experience centres.

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Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

M:

Male

R:

Rural

ERPC:

Endoscopic retrograde cholangiopancreatography

EGD:

Esophagogastroduodenoscopy

UGIB:

Upper gastro-intestinal bleeding

PD:

Pancreaticoduodenectomy

EPD:

Emergency pancreaticoduodenectomy

cl:

Classic Whipple

pp:

Pylorus-preserving

PG:

Pancreaticogastric anastomosis

PJ:

Pancreaticojejunal anastomosis

HJ:

Hepaticojejunostomy

JS:

Jejunostomy

PS:

Pancreaticostomy

HS:

Hepaticostomy

GS:

Gastrostomy

CPS:

Closure of pancreatic stump

HG:

Hepaticogastrostomy

TP:

Total pancreatectomy

po:

Postoperative days

BMI:

Body mass index

OR:

Operating room

POPF:

Postoperative pancreatic fistula

LOS:

Length of stay

NSQIP:

American College of Surgeons National Surgical Quality Improvement

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Authors and Affiliations

  1. Depatment of Surgery, Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania. Street Emil Isac no 13, 400023, Cluj-Napoca-Napoca, Romania

    C. Popa, D. Schlanger, F. Zaharie & N. Al Hajjar

  2. Surgery Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Cluj-Napoca-Napoca, Romania. Street Croitorilor no 19-21, 400162, Cluj-Napoca-Napoca, Romania

    C. Popa, D. Schlanger, F. Zaharie & N. Al Hajjar

  3. Department of Digestive and Emergency Surgery, University Hospital of Grenoble, Grenoble Alpes University, Grenoble, France

    M. Chirică

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Contributions

CP, DS and NA created the study design. The data collection was done by DS, CP and FZ. DS, CP and MC were involved in data analysis and interpretation. DS, CP and MC have written the manuscript. NA and MC substantially revised the manuscript.

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Correspondence to D. Schlanger.

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Popa, C., Schlanger, D., Chirică, M. et al. Emergency pancreaticoduodenectomy for non-traumatic indications—a systematic review. Langenbecks Arch Surg 407, 3169–3192 (2022). https://doi.org/10.1007/s00423-022-02702-6

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