Multifactorial Analysis of 233 Pancreaticoduodenectomy Cases Related to Risk Factors of Postoperative Complications and Death_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Zhanpei , PU Qingfan , ZHOU Yong

1.Department of General Surgery， West China Hospital， Sichuan University， Chengdu 610041， China;;
2.The First Department of Surgery, The Third Affiliated Hospital of Wenzhou Medical College, Ruian 325200, China;

Corresponding author：

Keywords：

Pancreaticoduonectomy,Postoperative complication,Risk factor

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【Abstract】 Objective To multifactorially analyze the risk factors related to the post-pancreaticoduodenectomy (PD) complications and death. Methods Two hundred and thirty-three PD cases were analyzed, average age 56, of those cases, 210 malignant with 72 pancreatic head and 138 periampullary involvement, 23 benign. Fifty-nine cases suffered coexisting vital organ disorders. Results Sixty-three cases (27.0%) experienced postoperative complications, among those 58 cases (24.9%) early complications, 28(12.0%) infection, 15(6.4%) organ systemic disorder, 14(6.0%) bleeding, 12(5.2%) pancreatic fistula, 15(6.4%) reoperations, 16 postoperative death during hospitalization. The independent risk factors related to the postoperative complications included coexisting vital organ disorders, operation methods, main pancreatic duct (MPD) diameter and surgeon’s experiences, those related to the death during hospitalization included preoperative serum creatinine, coexisting vital organ disorders, surgeon’s experiences; those related to the reoperation included preoperative CA19-9, surgeon’s experiences, tumor diameters, lymph nodes metastasis; and those related to the pancreatic fistula included operation methods, MPD diameters and surgeon’s experiences. Conclusion Coexisting vital organ disorders and surgeon’s experiences are the independent risk factors related to postoperative complications and death during hospitalization, operation methods, MPD diameter and surgeon’s experiences are the independent risk factors related to the pancreatic fistula. Thus, it is very important to choose the appropriate PD candidates, select the right operation method and to familiarize the operation.

Citation： LIU Zhanpei,PU Qingfan,ZHOU Yong. Multifactorial Analysis of 233 Pancreaticoduodenectomy Cases Related to Risk Factors of Postoperative Complications and Death. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2008, 15(3): 195-200. doi: Copy

1.	20 Lin JW, Cameron JL, Yeo CJ, et al. Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula [Ｊ] . J Gastrointest Surg, 2004; 8(8) ∶ 951.
2.	Schmidt CM, Powell ES, Yiannoutsos CT, et al. Pancreaticoduodenectomy: A 20-year experience in 516 patients [Ｊ]. Arch Surg， 2004; 139(7)∶718.
3.	Riall TS, Cameron JL, Lillemoe KD, et al. Resected periampullary adenocarcinoma: 5-year survivors and their 6- to 10-year follow-up [Ｊ]. Surgery, 2006; 140(5)∶764.
4.	Aerts R, Hendrickx T, Fieuws S, et al. Determinants of complications in pancreaticoduodenectomy [Ｊ]. Eur J Surg Onco, 2007; 33(4)∶448.
5.	Smith SL, Rae D, Sinclair M, et al. Does moderate celiac axis stenosis identified on preoperative multidetector computed tomographic angiography predict an increased risk of complications after pancreaticoduodenectomy for malignant pancreatic tumors? [Ｊ]. Pancreas, 2007; 34(1)∶80.
6.	Weinter JM, Cameron JL, Yeo CJ, et al. Biochemical markers predict morbidity and mortality after pancreaticoduodenectomy [Ｊ]. J Am Coll of Surg, 2007; 204(5)∶1029.
7.	Suzuki Y, Fujino Y, Ajiki T, et al. No mortality among 100 consecutive pancreaticoduodenectomies in a middle-volume center [Ｊ]. World J Surg, 2005; 29(11)∶1409.
8.	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.
9.	Kazanjian KK, Hines OJ, Eibl G, et al. Management of pancreatic fistulas after pancreaticoduodenectomy: results in 437 consecutive patients [Ｊ]. Arch Surg, 2005; 140(9)∶849.
10.	Wada K, Traverso LW. Pancreatic anastomotic leak after the Whipple procedure is reduced using the surgical microscope [Ｊ]. Surgery, 2006; 139(6)∶735.
11.	Aranha GV, Aaron JM, Shoup M, et al. Current management of pancreatic fistula after pancreaticoduodenectomy [Ｊ]. Surgery, 2006; 140(4)∶561.
12.	Gouma DJ, van Geenen RC, van Gulik TM, et al. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume [Ｊ]. Ann Surg, 2000; 232(6)∶786.
13.	徐来喜，余少鸿，何振平. 胰十二指肠切除术后严重并发症的防治体会 [Ｊ]. 中国普外基础与临床杂志， 2006； 13（6）∶714.
14.	彭承宏，程东峰，沈柏用，等. 胰十二指肠切除术联合血管切除的术前、术中评估和操作要点 [Ｊ]. 中国普外基础与临床杂志， 2006； 13（5）∶506.
15.	Satoi S, Takai S, Matsui Y, et al. Less morbidity after pancreaticoduodenectomy of patients with pancreatic cancer [Ｊ]. Pancreas, 2006; 33(1)∶45.
16.	Ferrone CR, Finkelstein DM, Thayer SP, et al. Perioperative CA19-9 levels can predict stage and survival in patients with resectable pancreatic adenocarcinoma [Ｊ]. J Clin Oncol, 2006; 24(18)∶2897.
17.	Harvey J, Dardik H, Impeduglia T, et al. Endovascular management of hepatic artery pseudoaneurysm hemorrhage complicating pancreaticoduodenectomy [Ｊ]. J Vasc Surg, 2006; 43(3)∶613.
18.	Butturini G, Marcucci S, Molinari E, et al. Complications after pancreaticoduodenectomy: the problem of current definitions [Ｊ]. J Hepatobiliary Pancreat Surg, 2006; 13(3)∶207.
19.	Wente MN, Shrikhande SV, Kleeff J, et al. Management of early hemorrhage from pancreatic anastomoses after pancreaticoduodenectomy [Ｊ]. Dig Surg, 2006; 23(4)∶203.
20.	Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition [Ｊ]. Surgery, 2005; 138(1)∶8.

1. 20 Lin JW, Cameron JL, Yeo CJ, et al. Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula [Ｊ] . J Gastrointest Surg, 2004; 8(8) ∶ 951.
2. Schmidt CM, Powell ES, Yiannoutsos CT, et al. Pancreaticoduodenectomy: A 20-year experience in 516 patients [Ｊ]. Arch Surg， 2004; 139(7)∶718.
3. Riall TS, Cameron JL, Lillemoe KD, et al. Resected periampullary adenocarcinoma: 5-year survivors and their 6- to 10-year follow-up [Ｊ]. Surgery, 2006; 140(5)∶764.
4. Aerts R, Hendrickx T, Fieuws S, et al. Determinants of complications in pancreaticoduodenectomy [Ｊ]. Eur J Surg Onco, 2007; 33(4)∶448.
5. Smith SL, Rae D, Sinclair M, et al. Does moderate celiac axis stenosis identified on preoperative multidetector computed tomographic angiography predict an increased risk of complications after pancreaticoduodenectomy for malignant pancreatic tumors? [Ｊ]. Pancreas, 2007; 34(1)∶80.
6. Weinter JM, Cameron JL, Yeo CJ, et al. Biochemical markers predict morbidity and mortality after pancreaticoduodenectomy [Ｊ]. J Am Coll of Surg, 2007; 204(5)∶1029.
7. Suzuki Y, Fujino Y, Ajiki T, et al. No mortality among 100 consecutive pancreaticoduodenectomies in a middle-volume center [Ｊ]. World J Surg, 2005; 29(11)∶1409.
8. 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.
9. Kazanjian KK, Hines OJ, Eibl G, et al. Management of pancreatic fistulas after pancreaticoduodenectomy: results in 437 consecutive patients [Ｊ]. Arch Surg, 2005; 140(9)∶849.
10. Wada K, Traverso LW. Pancreatic anastomotic leak after the Whipple procedure is reduced using the surgical microscope [Ｊ]. Surgery, 2006; 139(6)∶735.
11. Aranha GV, Aaron JM, Shoup M, et al. Current management of pancreatic fistula after pancreaticoduodenectomy [Ｊ]. Surgery, 2006; 140(4)∶561.
12. Gouma DJ, van Geenen RC, van Gulik TM, et al. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume [Ｊ]. Ann Surg, 2000; 232(6)∶786.
13. 徐来喜，余少鸿，何振平. 胰十二指肠切除术后严重并发症的防治体会 [Ｊ]. 中国普外基础与临床杂志， 2006； 13（6）∶714.
14. 彭承宏，程东峰，沈柏用，等. 胰十二指肠切除术联合血管切除的术前、术中评估和操作要点 [Ｊ]. 中国普外基础与临床杂志， 2006； 13（5）∶506.
15. Satoi S, Takai S, Matsui Y, et al. Less morbidity after pancreaticoduodenectomy of patients with pancreatic cancer [Ｊ]. Pancreas, 2006; 33(1)∶45.
16. Ferrone CR, Finkelstein DM, Thayer SP, et al. Perioperative CA19-9 levels can predict stage and survival in patients with resectable pancreatic adenocarcinoma [Ｊ]. J Clin Oncol, 2006; 24(18)∶2897.
17. Harvey J, Dardik H, Impeduglia T, et al. Endovascular management of hepatic artery pseudoaneurysm hemorrhage complicating pancreaticoduodenectomy [Ｊ]. J Vasc Surg, 2006; 43(3)∶613.
18. Butturini G, Marcucci S, Molinari E, et al. Complications after pancreaticoduodenectomy: the problem of current definitions [Ｊ]. J Hepatobiliary Pancreat Surg, 2006; 13(3)∶207.
19. Wente MN, Shrikhande SV, Kleeff J, et al. Management of early hemorrhage from pancreatic anastomoses after pancreaticoduodenectomy [Ｊ]. Dig Surg, 2006; 23(4)∶203.
20. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition [Ｊ]. Surgery, 2005; 138(1)∶8.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Multifactorial Analysis of 233 Pancreaticoduodenectomy Cases Related to Risk Factors of Postoperative Complications and Death

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