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

Abstract

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.

Pancreaticoduodenectomy for a primary duodenal capicua transcriptional repressor (CIC) -rearranged sarcoma with severe bleeding: a case report

“…Retrospectively this surgical strategy seemed to be appropriate treatment for a CICrearranged sarcoma. Pancreaticoduodenectomy is a technically demanding and complex procedure with a relatively high rate of complications and morbidity despite refinement of preoperative management and surgical technique [15]. Some authors propose a staged reconstruction to minimize the complications for emergent pancreaticoduodenectomy [16].…”

Colo-pancreaticoduodenectomy for Locally Advanced Colon Carcinoma- Feasibility in Patients Manifesting as Acute Abdomen

“…All their patients were relatively young and healthy without associated troublesome co-morbidities. The risks of emergent PD for non-trauma patients are usually higher than trauma cases, because these patients usually have unrecognized preoperative poor conditions and ill-controlled coexisted in ammation or organ dysfunction that resulted in a failed emergent PD (30,31,33).…”

“…On the other hand, Kausch in Germany and Whipple in USA demonstrated rst the brief techniques of PD during the early 20th century. This operation procedure is also known as the "Kausch-Whipple operation" (26) for treating neoplasms or complex injuries or diseases involving duodenum and pancreatic head (26)(27)(28)(29)(30)(31)(32)(33)(34). Recently, despite the lowered operative mortality of PD to <5%, its complication rate remains high (up to > 40% in the recent literatures) (26)(27)(28)(29)(30)(31)(32)(33)(34).…”

“…The complexity of cPD is even greater over PD, and cPD further has higher operative morbidities and mortalities . Moreover, PD performed during emergency condition also are more risky (20,(27)(28)(29)(30)(31)33). Operative mortality related to emergent PD exceeds 20 to 40% (20,(27)(28)(29)(30)(31)33).…”

“…Moreover, PD performed during emergency condition also are more risky (20,(27)(28)(29)(30)(31)33). Operative mortality related to emergent PD exceeds 20 to 40% (20,(27)(28)(29)(30)(31)33). Patient's preoperative condition and its PD etiology are important factors affecting safety issues of emergent PD (29)(30)(31)33).…”