Javier Herrera1, Cruz Zazpe1, Pablo Sánchez2, Antonio Tarifa1, Inés Eguaras1, José Miguel Lera1. 1. Unidad Hepatopancreatobiliar, Complejo Hospitalario de Navarra, Pamplona, Navarra, España. 2. Unidad Hepatopancreatobiliar, Complejo Hospitalario de Navarra, Pamplona, Navarra, España. Electronic address: pablosanchez_84@hotmail.com.
Abstract
BACKGROUND: Postoperative mortality associated with pancreaticoduodenectomy (PD) in high-volume hospitals is below 5%, yet morbidity rates range between 45% and 60%. Recent studies show a lower incidence of complications and postoperative pancreatic fistula (POPF) in pancreaticogastrostomy (PG). The primary objective was to assess the incidence and predictive factors for complications: POPF, post-pancreatectomy hemorrhage (PPH) and delayed gastric emptying (DGE) following the criteria of the ISGPS and Clavien-Dindo classifications. METHODS: A prospective observational study that included all patients who underwent PD between 2008 and 2016. PG was the surgical procedure of choice for PD reconstruction. RESULTS: Two hundred forty-nine patients underwent surgery with intention of performing a PD. The feasibility of PG was 90.5%. One hundred and six (53%) patients had complications, 36 (18%) were severe (Clavien-Dindo grade ≥III). Death within 90 postoperative days was 4%. DGE was the most frequent complication (22.5%), followed by PPH (21%). The clinical POPF rate was 15% (6% Clavien-Dindo grade ≥III). The primary risk factors associated with complications were age >70 years (1.9 [1-3.55]), being male (1.89 [1; 3.6]) and soft pancreatic texture (3.38 [1.5; 7.37]). CONCLUSIONS: In this paper, we report a feasibility study for PG (90.5%). The primary risk factors associated with complications were age >70 years, being male and soft pancreatic texture. Soft pancreatic texture is also associated with the development and severity of POPF.
BACKGROUND: Postoperative mortality associated with pancreaticoduodenectomy (PD) in high-volume hospitals is below 5%, yet morbidity rates range between 45% and 60%. Recent studies show a lower incidence of complications and postoperative pancreatic fistula (POPF) in pancreaticogastrostomy (PG). The primary objective was to assess the incidence and predictive factors for complications: POPF, post-pancreatectomy hemorrhage (PPH) and delayed gastric emptying (DGE) following the criteria of the ISGPS and Clavien-Dindo classifications. METHODS: A prospective observational study that included all patients who underwent PD between 2008 and 2016. PG was the surgical procedure of choice for PD reconstruction. RESULTS: Two hundred forty-nine patients underwent surgery with intention of performing a PD. The feasibility of PG was 90.5%. One hundred and six (53%) patients had complications, 36 (18%) were severe (Clavien-Dindo grade ≥III). Death within 90 postoperative days was 4%. DGE was the most frequent complication (22.5%), followed by PPH (21%). The clinical POPF rate was 15% (6% Clavien-Dindo grade ≥III). The primary risk factors associated with complications were age >70 years (1.9 [1-3.55]), being male (1.89 [1; 3.6]) and soft pancreatic texture (3.38 [1.5; 7.37]). CONCLUSIONS: In this paper, we report a feasibility study for PG (90.5%). The primary risk factors associated with complications were age >70 years, being male and soft pancreatic texture. Soft pancreatic texture is also associated with the development and severity of POPF.