Emergency pancreaticoduodenectomy: When is it needed? A dual non-trauma centre experience and literature review

Lissidini, Germana; Prete, Francesco Paolo; Piccinni, Giuseppe; Gurrado, Angela; Giungato, Simone; Prete, Fernando; Testini, Mario

doi:10.1016/j.ijsu.2015.04.096

Cited by 27 publications

(36 citation statements)

References 42 publications

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“…Table 2 presented 31 EPD accounting for 1.84% of all 2984 cases who underwent EPD for non-traumatic etiologies from the literature and the present series [8, 11, 14–22]. The rate of EPD for non-traumatic etiologies is similar between the present study and the other 3 series, ranging from 0.3 to 3%.…”

Section: Resultssupporting

confidence: 71%

The impact of preoperative etiology on emergent pancreaticoduodenectomy for non-traumatic patients

et al. 2017

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BackgroundEmergent pancreaticoduodenectomy is a life-saving procedure in certain clinical scenarios when all the conservative treatment fails. The indications can be limited into perforation and bleeding. To clarify the impact of etiology on surgical outcomes of emergent pancreaticoduodenectomy for non-trauma, we analyzed our patients and performed a literature review.MethodsWe reviewed 931 consecutive pancreaticoduodenectomies performed at our institute between January 2001 and July 2015. Patients with emergent pancreaticoduodenectomy for non-trauma etiologies were enrolled, whereas those who suffered from caustic injuries were excluded. The keywords “emergent/emergency” and “pancreaticoduodenectomy/pancreatoduodenectomy” were applied in a literature search. The universally available data for all the enrolled patients including etiology, surgical complications, outcomes, and hospital stays were analyzed. Univariate and multivariate logistic analysis for the contributing factors to surgical mortality were performed.ResultsSix out of 931 (0.6%) registered pancreaticoduodenectomies matched our criteria of inclusion. The literature review obtained 4 series and 7 case reports, which when combined with our patients yielded a cohort of 31 emergent pancreaticoduodenectomies with 13 cases of perforation and 18 of bleeding. The rate of emergent pancreaticoduodenectomy for non-traumatic etiologies is similar between the present study and the other 3 series, ranging from 0.3 to 3%. The overall surgical complication rate was 83.9%. The rate of surgical mortality is significantly higher than in elective pancreaticoduodenectomy by propensity score matching with age and gender (19.4 versus 3.2%, P = 0.015). Univariate and multivariate logistic regression disclosed that etiology is the only preoperative risk factor for surgical mortality (perforation versus bleeding; odds ratio = 39.494, P = 0.031).ConclusionsEmergent pancreaticoduodenectomy remains a rare operation. Surgical morbidity and mortality are higher than with elective pancreaticoduodenectomy among different reported series. By sorting the preoperative etiologies into two groups, perforation carries a higher risk of surgical mortality than bleeding.

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Section: Resultssupporting

confidence: 71%

The impact of preoperative etiology on emergent pancreaticoduodenectomy for non-traumatic patients

et al. 2017

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“…Tumoral bleeding is also an indication of embolization, but locally advanced tumors usually have multiple arterial feeders, from the gastroduodenal artery and the superior mesenteric artery, rendering embolization difficult or insufficient. Moreover, interventional radiological procedures are only palliative for neoplasia and even for late bleeding complications of necrotizing pancreatitis [4]. Therefore, in specific situations, EPD is a definitive therapeutic procedure, especially in patients with bleeding malignancies as it allows either rapid and steady hemostasis or removal of the lesion.…”

Section: Discussionmentioning

confidence: 99%

Emergency Backwards Whipple for Bleeding: Formidable and Definitive Surgery

Lupașcu

Trofin

Zabara

et al. 2017

Gastroenterology Research and Practice

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Introduction During the past decades, the safety of pancreatoduodenectomy has improved, with low mortality and reduced morbidity, particularly in centers with extensive experience. Emergency pancreatoduodenectomy is an uncommon event, for treatment of pancreaticoduodenal trauma, bleeding, or perforation. We herein present a single center experience concerning nontrauma emergency pancreatoduodenectomy for pancreaticoduodenal bleeding. Methods From January 2007 to December 2015, from a population of 134 PD (70 males and 64 females, mean age 62.2, range 34–82), 5 patients (3.7%; 2 males and 3 females, mean age 64, range 57–70) underwent one-stage emergency pancreatoduodenectomy for uncontrollable nontrauma pancreaticoduodenal bleeding in our tertiary center. Results All the 5 patients underwent a backwards Whipple with a morbidity of 60% and a mortality of 20% (1/5). The other 4 patients were recovered and discharged with a median postoperative length of stay of 17 days (range 14–23). Conclusion Emergency pancreatoduodenectomy is a definitive life-saving procedure allowing for a rapid control of bleeding when other less invasive approaches (transcatheter arterial embolization or interventional endoscopy) are exhausted, unavailable, or unsafe. It should be particularly considered in neoplastic disease and tailored by surgeons with a high level of experience in pancreatic surgery.

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“…A surgical team familiar with HPB surgery can adapt to the emergency situation and also provide better postoperative care because it is customized with post-op complications and can treat them accordingly. Interdisciplinary communication and expertise can provide better outcomes (6,7).…”

Section: Discusionsmentioning

confidence: 99%

“…Prognosis depends on the timing to intervention, the experience of the operating surgeon, on the peri-and postoperative anesthesiological management and on the radiological management of postoperative complications (6,7).…”

Section: Discusionsmentioning

confidence: 99%

Emergency Pancreatico-Duodenectomy with Superior Mesenteric and Portal Vein Resection and Reconstruction Using a Gore-Tex Vascular Graft

Eftimie¹,

Lungu²,

Tudoroiu³

et al. 2017

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RezumatDuodenopancreatectomia efectuatã în urgenţã este o procedurã chirurgicalã rarã şi ca urmare puţine cazuri sunt prezentate în literaturã. Este un abord folosit în puţine cazuri, fiind indicat în tratamentul chirurgical de urgenţã al traumelor abdominale ce implicã regiunea cefalopancreaticã sau duodenul, fiind şi o unealtã utilã în tratamentul anevrismelor rupte, pseudochistelor hemoragice, perforaţiilor duodenale, hemoragiei necontrolate de la nivelul ulcerelor sau tumorilor duodenale, complicaţiilor septice severe ale pancreatitei acute şi în tratamentul complicaţiilor secundare manevrelor asociate colangiopancreatografiei retrograde (1,2). Este folositã în puţine cazuri ca şi primã linie de tratament chirurgical al sângerãrilor acute datorate pseudoanevrismelor rupte ale arterelor regiunii cefalopancreatice. Prezentãm cazul unei sângerãri acute de la nivelul unui pseudoanevrism al regiunii cefalopancreatice prezent la un pacient tânãr cu pancreatitã cronicã, nediagnosticatã pânã la momentul debutului bolii şi la care s-a ridicat suspiciunea unei formaţiuni tumorale a regiunii cefalopancreatice. Am efectuat o duodenopancreatectomie cu rezecţie de venã mezentericã superioarã şi de venã portã cu reconstrucţie venoasã folosind grefon sintetic de Gore-Tex® datoritã posibilei invazii tumorale la nivel venos. Evoluţia postoperatorie a fost marcatã de apariţia unei fistule pancreatice minore, remisã sub tratament conservator. Concluzionãm cã acest abord este util în tratamentul acestor cazuri atât ca primã linie de tratament sau secundar abordului endovascular (stentare sau embolizare).Cuvinte cheie: duodenopancreatectomie cefalicã, rezecţie vascularã, rezecţie pancreaticã în urgenţã, reconstrucţie vascularã Abstract Emergency pancreatico-duodenectomy(EPD) is a very rare procedure and few reports are present in medical literature. It is an uncommon approach, usually

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Emergency pancreaticoduodenectomy: When is it needed? A dual non-trauma centre experience and literature review

Cited by 27 publications

References 42 publications

The impact of preoperative etiology on emergent pancreaticoduodenectomy for non-traumatic patients

The impact of preoperative etiology on emergent pancreaticoduodenectomy for non-traumatic patients

Emergency Backwards Whipple for Bleeding: Formidable and Definitive Surgery

Emergency Pancreatico-Duodenectomy with Superior Mesenteric and Portal Vein Resection and Reconstruction Using a Gore-Tex Vascular Graft

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