Pancreatic fistula and mortality after surgical management of pancreatic trauma: analysis of 81 consecutive patients during 11 years at a Korean trauma center

Abstract

PurposePancreatic trauma is infrequent because of its central, deep anatomical position. This contributes to a lack of surgeon experience and many debates exist about its standard care. This study aimed to investigate the postoperative pancreatic fistula (POPF) and mortality of pancreatic trauma after operation.MethodsWe reviewed records in the trauma registry of our institution submitted from January 2006 to December 2016. The grade of pancreatic injury, surgical management, morbidity, mortality, and other clinical variables included in the analyses.ResultsData from a total of 26,072 trauma patients admitted to the Emergency Department were analyzed. Pancreatic trauma was observed in 114 of these patients (0.44%). Laparotomy was performed in 81 patients (2 pan creatico duodenectomies, 2 pancreaticogastrostomies, peripancreatic drainage in 41 patients, distal pancreatectomies in 34 patients, and 9 patients who underwent surgery for damage control). The incidence of POPF was 38.3%. The overall mortality was 8.8% (7 of 81). In multivariate analysis, pancreas injury grade IV (≥4) (adjusted odds ratio [AOR], 4.071; P = 0.029) and preoperative peritonitis signs (AOR, 2.903; P = 0.039) were independent risk factors for POPF. All patients who died had also another major abdominal injury (≥grade 3). Multiorgan failure was a major cause of death (6 of 7, 85.7%). The mortality rate of isolated pancreas injury was 0%.ConclusionThe pancreas injury grade and preoperative peritonitis were significant risk factors of POPF. The mortality rate of isolated pancreatic trauma was very low.

Current status and management of pancreatic trauma with main pancreatic duct injury: A multicenter nationwide survey in Japan

“…This multicenter nationwide survey conducted over the last decade revealed that mortality was 5% for all cases, 1.8% for patients with isolated pancreatic injury, and 3% for patients with MPD injury. This mortality rate was similar to that reported in previous studies, which found that the mortality rate is 0%‐10% 2,4,14,15 …”

“…It has been previously reported that emergency PD for pancreatic injury was associated with a very high mortality rate (>30%) because of the patient's poor condition and surgical complexity. 14,25 However, compared with the outcomes of these previous reports, the outcome of PD in this recent series was excellent with zero mortality. This is presumably because the attending centers are all JSAEM board-certified hospitals that have abundant experiences in abdominal emergencies.…”

“…This mortality rate was similar to that reported in previous studies, which found that the mortality rate is 0%-10%. 2,4,14,15 Age distribution was analyzed in male and female patients. Young patients were more common regardless of sex.…”

Surgical management of traumatic pancreatic injuries and their consequences.

“…Our morbidity and mortality rates are in agreement with the available literature, which shows similar or higher morbidity and mortality, particularly with increasing injury grades and hemodynamic instability. 2,7,11,31 Among the limitations of this study is the relatively small number of patients. Likewise, lack of interventional management using pancreatic duct stenting could have avoided the need of surgical intervention in a substantial number of patients.…”

“…5 Pancreatic trauma might trigger several consequences including pancreatic leaks, abscesses, pseudocysts, pancreatitis and pancreatic necrosis. [6][7][8][9][10] The risk of complications and mortality should be considered with extensive parenchymal and ductal injuries as well as when the diagnosis is delayed. 11,12 Evaluation of the extent of pancreatic injury by various imaging techniques in the setting of abdominal trauma might be demanding.…”