Risk Factors of Intraabdominal Complications and Operative Death after Pancreatoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YANGSun-hu ¹ ,  HUANGMing-zhe ¹ , LIFeng ¹ , LIPo ² , ZHANGZhen-ming ²

1. Department of General Surgery, The Third People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 201900, China;
2. Department of General Surgery, People's Hospital of Zhangye City, Zhangye 734000, Gansu Province, China;

Corresponding?author：

HUANGMing-zhe, Email: 18993622268@189.cn

Keywords：

Pancreaticoduodenectomy; Complication; Pancreatic fistula; Operative death; Influence factor

DOI：

10.7507/1007-9424.20140074

Video：

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Objective To explore the risk factors of intraabdominal complications (IACs), pancreatic fistula (PF), and operative death after pancreatoduodenectomy (PD), and to provide a theoretical basis in reducing the rates of them. Methods Clinical data of 78 patients who underwent standard PD surgery in The Third People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from Jun. 2003 to Nov. 2011 were collected to analyze the influence factors of IACs, PF, and operative death. Results There were 29 cases suffered IACs (13 cases of PF included), and 6 case died during 1 month after operation. Univariate analysis results showed that IACs and PF occurred more often in patients with soft friable pancreas, diameter of main pancreatic duct less than 3 mm, preoperative biliary drainage, no pancreatic duct stenting, and without employment of somatostatin (P < 0.05), no influence factor was found to be related to operative death. Multivariate analysis results showed that patients with no pancreatic duct stenting (OR=1.867, P=0.000), soft texture of remnant stump (OR=1.356, P=0.046), and diameter of main pancreatic duct less than 3 mm (OR=2.874, P=0.015) suffered more IACs; PF was more frequent in patient with no pancreatic duct stenting (OR=1.672, P=0.030), soft texture of remnant stump (OR=1.946, P=0.042), and diameter of main pancreatic duct less than 3 mm (OR=1.782, P=0.002);no independent factor was found to have relationship with operative death. Conclusions Soft texture of remnant stump, diameter of main pancreatic duct less than 3 mm, and no pancreatic duct stenting are independent risk factors that should be considered in indications for PD surgery.

Citation： YANGSun-hu, HUANGMing-zhe, LIFeng, LIPo, ZHANGZhen-ming. Risk Factors of Intraabdominal Complications and Operative Death after Pancreatoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(3): 313-317. doi: 10.7507/1007-9424.20140074 Copy

1.	?Gouma DJ, van Geenen RC, van Gulik TM, et al. Rates of comp-lications and death after pancreaticoduodenectomy:risk factors and the impact of hospital volume[J]. Ann Surg, 2000, 232(6):786-795.
2.	袁偉升, 劉鵬, 陳鍵鋒, 等.保留幽門的胰十二指腸切除術37例療效分析[J].中國普外基礎與臨床雜志, 2012, 19(6):665-667.
3.	顧鈞, 吳文廣, 丁琦晨, 等.胰十二指腸切除術后出血的危險因素及其診治[J].中國普外基礎與臨床雜志, 2012, 19(6):653-656.
4.	Martin RC 2nd, Brennan MF, Jaques DP. Quality of complication reporting in the surgical literature[J]. Ann Surg, 2002, 235(6):803-813.
5.	呂飛飛, 趙海平, 王震俠, 等.胰十二指腸切除改良胰管空腸吻合預防胰瘺的臨床研究[J].中國普外基礎與臨床雜志, 2012, 19(4):391-395.
6.	Ho V, Heslin MJ. Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy[J]. Ann Surg, 2003, 237(4):509-514.
7.	朱震宇, 黃志強.胰腸吻合方法的探索[J].中國普外基礎與臨床雜志, 2012, 19(4):368-371.
8.	Büchler MW, Wagner M, Schmied BM, et al. Changes in morbidity after pancreatic resection:toward the end of completion pancreatectomy[J]. Arch Surg, 2003, 138(12):1310-1314.
9.	席鵬程, 時開網, 楊坤興.胰管內徑對胰十二指腸切除術后胰瘺發生率的影響[J].中國普外基礎與臨床雜志, 2009, 16(8):609-612.
10.	劉戰培, 蒲青凡, 周勇. 233例胰十二指腸切除術后并發癥及死亡危險因素多因素分析[J].中國普外基礎與臨床雜志, 2008, 15(3):195-200.
11.	Sato N, Yamaguchi K, Chijiiwa K, et al. Risk analysis of pancr-eatic fistula after pancreatic head resection[J]. Arch Surg, 1998, 133(10):1094-1098.
12.	Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula:an international study group (ISGPF) definition[J]. Surgery, 2005, 138(1):8-13.
13.	Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery:a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS)[J]. Surgery, 2007, 142(5):761-768.
14.	Yekebas EF, Wolfram L, Cataldegirmen G, et al. Postpancreatectomy hemorrhage:diagnosis and treatment:an analysis in 1669 consecutive pancreatic resections[J]. Ann Surg, 2007, 246(2):269-280.
15.	Dindo D, Demartines N, Clavien PA. Classification of surgical complications:a new proposal with evaluation in a cohort of 6336 patients and results of a survey[J]. Ann Surg, 2004, 240(2):205-213.
16.	陳泉寧, 彭承宏, 范躍祖, 等.胰胃吻合在胰十二指腸切除術中的應用[J].中國普外基礎與臨床雜志, 2009, 16(3):223-225.
17.	Bartoli FG, Arnone GB, Ravera G, et al. Pancreatic fistula and relative mortality in malignant disease after pancreaticoduodenectomy. Review and statistical meta-analysis regarding 15 years of literature[J]. Anticancer Res, 1991, 11(5):1831-1848.
18.	王志遠, 劉鵬, 袁偉升, 等.荷包套入式胰空腸雙重吻合術在胰十二指腸切除術中的應用[J].中國普外基礎與臨床雜志, 2008, 15(12):920-922.
19.	張春秋, 王國華, 彭曉暉, 等.捆綁式胰腸吻合術在預防胰十二指腸切除術后胰瘺發生中的臨床應用[J].中國普外基礎與臨床雜志, 2008, 15(8):565-566.
20.	Muscari F, Suc B, Kirzin S, et al. Risk factors for mortality and intra-abdominal complications after pancreatoduodenectomy:multivariate analysis in 300 patients[J]. Surgery, 2006, 139(5):591-598.
21.	Niedergethmann M, Dusch N, Widyaningsih R, et al. Risk-adapted anastomosis for partial pancreaticoduodenectomy reduces the risk of pancreatic fistula:a pilot study[J]. World J Surg, 2010, 34(7):1579-1586.
22.	Yang SH, Dou KF, Sharma N, et al. The methods of reconstruction of pancreatic digestive continuity after pancreaticoduodenectomy:a meta-analysis of randomized controlled trials[J]. World J Surg, 2011, 35(10):2290-2297.
23.	Duffas JP, Suc B, Msika S, et al. A controlled randomized multi-center trial of pancreatogastrostomy or pancreatojejunostomy after pancreatoduodenectomy[J]. Am J Surg, 2005, 189(6):720-729.
24.	張倜, 李慧鍇, 李強.胰十二指腸切除術后胰瘺發生風險預測系統的臨床價值[J].中華消化外科雜志, 2013, 12(8):569-572.
25.	謝亞娣, 左曉艷, 劉星, 等. 10例嚴重胰腺損傷行胰胃吻合并胰管外引流術的護理[J].中華護理雜志, 2013, 48(7):590-592.
26.	Poon RT, Fan ST, Lo CM, et al. External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy:a prospective randomized trial[J]. Ann Surg, 2007, 246(3):425-433.
27.	Alghamdi AA, Jawas AM, Hart RS. Use of octreotide for the prevention of pancreatic fistula after elective pancreatic surgery:a systematic review and meta-analysis[J]. Can J Surg, 2007, 50(6):459-466.
28.	Closset J, Journe S, Mboti F, et al. Randomized controlled trial comparing somatostatin with octreotide in the prevention of complications after pancreatectomy[J]. Hepatogastroenterology, 2008, 55(86-87):1818-1823.
29.	van der Gaag NA, Rauws EA, van Eijck CH, et al. Preoperative biliary drainage for cancer of the head of the pancreas[J]. N Engl J Med, 2010, 362(2):129-137.

1. ?Gouma DJ, van Geenen RC, van Gulik TM, et al. Rates of comp-lications and death after pancreaticoduodenectomy:risk factors and the impact of hospital volume[J]. Ann Surg, 2000, 232(6):786-795.
2. 袁偉升, 劉鵬, 陳鍵鋒, 等.保留幽門的胰十二指腸切除術37例療效分析[J].中國普外基礎與臨床雜志, 2012, 19(6):665-667.
3. 顧鈞, 吳文廣, 丁琦晨, 等.胰十二指腸切除術后出血的危險因素及其診治[J].中國普外基礎與臨床雜志, 2012, 19(6):653-656.
4. Martin RC 2nd, Brennan MF, Jaques DP. Quality of complication reporting in the surgical literature[J]. Ann Surg, 2002, 235(6):803-813.
5. 呂飛飛, 趙海平, 王震俠, 等.胰十二指腸切除改良胰管空腸吻合預防胰瘺的臨床研究[J].中國普外基礎與臨床雜志, 2012, 19(4):391-395.
6. Ho V, Heslin MJ. Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy[J]. Ann Surg, 2003, 237(4):509-514.
7. 朱震宇, 黃志強.胰腸吻合方法的探索[J].中國普外基礎與臨床雜志, 2012, 19(4):368-371.
8. Büchler MW, Wagner M, Schmied BM, et al. Changes in morbidity after pancreatic resection:toward the end of completion pancreatectomy[J]. Arch Surg, 2003, 138(12):1310-1314.
9. 席鵬程, 時開網, 楊坤興.胰管內徑對胰十二指腸切除術后胰瘺發生率的影響[J].中國普外基礎與臨床雜志, 2009, 16(8):609-612.
10. 劉戰培, 蒲青凡, 周勇. 233例胰十二指腸切除術后并發癥及死亡危險因素多因素分析[J].中國普外基礎與臨床雜志, 2008, 15(3):195-200.
11. Sato N, Yamaguchi K, Chijiiwa K, et al. Risk analysis of pancr-eatic fistula after pancreatic head resection[J]. Arch Surg, 1998, 133(10):1094-1098.
12. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula:an international study group (ISGPF) definition[J]. Surgery, 2005, 138(1):8-13.
13. Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery:a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS)[J]. Surgery, 2007, 142(5):761-768.
14. Yekebas EF, Wolfram L, Cataldegirmen G, et al. Postpancreatectomy hemorrhage:diagnosis and treatment:an analysis in 1669 consecutive pancreatic resections[J]. Ann Surg, 2007, 246(2):269-280.
15. Dindo D, Demartines N, Clavien PA. Classification of surgical complications:a new proposal with evaluation in a cohort of 6336 patients and results of a survey[J]. Ann Surg, 2004, 240(2):205-213.
16. 陳泉寧, 彭承宏, 范躍祖, 等.胰胃吻合在胰十二指腸切除術中的應用[J].中國普外基礎與臨床雜志, 2009, 16(3):223-225.
17. Bartoli FG, Arnone GB, Ravera G, et al. Pancreatic fistula and relative mortality in malignant disease after pancreaticoduodenectomy. Review and statistical meta-analysis regarding 15 years of literature[J]. Anticancer Res, 1991, 11(5):1831-1848.
18. 王志遠, 劉鵬, 袁偉升, 等.荷包套入式胰空腸雙重吻合術在胰十二指腸切除術中的應用[J].中國普外基礎與臨床雜志, 2008, 15(12):920-922.
19. 張春秋, 王國華, 彭曉暉, 等.捆綁式胰腸吻合術在預防胰十二指腸切除術后胰瘺發生中的臨床應用[J].中國普外基礎與臨床雜志, 2008, 15(8):565-566.
20. Muscari F, Suc B, Kirzin S, et al. Risk factors for mortality and intra-abdominal complications after pancreatoduodenectomy:multivariate analysis in 300 patients[J]. Surgery, 2006, 139(5):591-598.
21. Niedergethmann M, Dusch N, Widyaningsih R, et al. Risk-adapted anastomosis for partial pancreaticoduodenectomy reduces the risk of pancreatic fistula:a pilot study[J]. World J Surg, 2010, 34(7):1579-1586.
22. Yang SH, Dou KF, Sharma N, et al. The methods of reconstruction of pancreatic digestive continuity after pancreaticoduodenectomy:a meta-analysis of randomized controlled trials[J]. World J Surg, 2011, 35(10):2290-2297.
23. Duffas JP, Suc B, Msika S, et al. A controlled randomized multi-center trial of pancreatogastrostomy or pancreatojejunostomy after pancreatoduodenectomy[J]. Am J Surg, 2005, 189(6):720-729.
24. 張倜, 李慧鍇, 李強.胰十二指腸切除術后胰瘺發生風險預測系統的臨床價值[J].中華消化外科雜志, 2013, 12(8):569-572.
25. 謝亞娣, 左曉艷, 劉星, 等. 10例嚴重胰腺損傷行胰胃吻合并胰管外引流術的護理[J].中華護理雜志, 2013, 48(7):590-592.
26. Poon RT, Fan ST, Lo CM, et al. External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy:a prospective randomized trial[J]. Ann Surg, 2007, 246(3):425-433.
27. Alghamdi AA, Jawas AM, Hart RS. Use of octreotide for the prevention of pancreatic fistula after elective pancreatic surgery:a systematic review and meta-analysis[J]. Can J Surg, 2007, 50(6):459-466.
28. Closset J, Journe S, Mboti F, et al. Randomized controlled trial comparing somatostatin with octreotide in the prevention of complications after pancreatectomy[J]. Hepatogastroenterology, 2008, 55(86-87):1818-1823.
29. van der Gaag NA, Rauws EA, van Eijck CH, et al. Preoperative biliary drainage for cancer of the head of the pancreas[J]. N Engl J Med, 2010, 362(2):129-137.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Risk Factors of Intraabdominal Complications and Operative Death after Pancreatoduodenectomy

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