Hung-Hsuan Yen1, Te-Wei Ho2, Chien-Hui Wu1, Ting-Chun Kuo1, Jin-Ming Wu1, Ching-Yao Yang1, Yu-Wen Tien1. 1. Division of General Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7 Chung-Shan South Road, Taipei, 10002, Taiwan. 2. Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan.
Abstract
BACKGROUND: The pancreatoenteric anastomotic stricture (PEAS) is a common long-term complication after pancreaticoduodenectomy (PD), some of which present as acute pancreatitis requiring emergency care. This important topic has never been reported. In this study, we focus on the incidence, radiological features, clinical outcome, and risk factors of late-occurring acute pancreatitis (LAP) after PD. METHODS: We retrospectively reviewed a prospectively collected database of 539 patients who underwent PD at a single tertiary referral center between June 2005 and December 2014. Only patients with at least 3 years of follow-up and available pre- and post-operative images were included. RESULTS: Of the 539 patients, 23 (15 [65%] with and eight [35%] without PEAS) were diagnosed with LAP after PD. The cumulative incidence of LAP was 3.6% (1-year), 4.4% (2-year), and 5.1% (5-year). The median time to the first LAP episode was 22 months (range 8-38 months) after PD. All the first and recurrent LAP events were mild in severity and resolved after conservative treatment. Multivariate analysis showed that a history of acute pancreatitis before PD (P = 0.001, HR 5.24, 95% CI 1.95-14.10) and PEAS (P = 0.047, HR 2.75, 95% CI 1.01-7.49) were two significant risk factors. CONCLUSIONS: We propose using a more conservative treatment for patients who experience LAP after PD.
BACKGROUND: The pancreatoenteric anastomotic stricture (PEAS) is a common long-term complication after pancreaticoduodenectomy (PD), some of which present as acute pancreatitis requiring emergency care. This important topic has never been reported. In this study, we focus on the incidence, radiological features, clinical outcome, and risk factors of late-occurring acute pancreatitis (LAP) after PD. METHODS: We retrospectively reviewed a prospectively collected database of 539 patients who underwent PD at a single tertiary referral center between June 2005 and December 2014. Only patients with at least 3 years of follow-up and available pre- and post-operative images were included. RESULTS: Of the 539 patients, 23 (15 [65%] with and eight [35%] without PEAS) were diagnosed with LAP after PD. The cumulative incidence of LAP was 3.6% (1-year), 4.4% (2-year), and 5.1% (5-year). The median time to the first LAP episode was 22 months (range 8-38 months) after PD. All the first and recurrent LAP events were mild in severity and resolved after conservative treatment. Multivariate analysis showed that a history of acute pancreatitis before PD (P = 0.001, HR 5.24, 95% CI 1.95-14.10) and PEAS (P = 0.047, HR 2.75, 95% CI 1.01-7.49) were two significant risk factors. CONCLUSIONS: We propose using a more conservative treatment for patients who experience LAP after PD.