Salvage Completion Pancreatectomies as Damage Control for Post-pancreatic Surgery Complications: A Single-Center Retrospective Analysis

Background Post-pancreatic surgical morbidity is frequent but often manageable by less invasive means than re-operation. Yet, some complications can become hazardous and life threatening. Herein, the results of a completion pancreatectomy (CP) to cope with severe post-operative pancreatic fistulas (...

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Bibliographic Details
Published in:World journal of surgery 2015-06, Vol.39 (6), p.1550-1556
Main Authors: Nentwich, Michael F., El Gammal, Alexander T., Lemcke, Torben, Ghadban, Tarik, Bellon, Eugen, Melling, Nathaniel, Bachmann, Kai, Reeh, Matthias, Uzunoglu, Faik G., Izbicki, Jakob R., Bockhorn, Maximilian
Format: Article
Language:English
Subjects:
Abdominal Surgery
Aged
Aged, 80 and over
Anastomotic Insufficiency
Anastomotic Leak - etiology
Anastomotic Leak - surgery
Cardiac Surgery
Female
General Surgery
Hospital Mortality
Humans
Length of Stay
Male
Medicine
Medicine & Public Health
Middle Aged
Original Scientific Report
Pancreas - surgery
Pancreatectomy - adverse effects
Pancreatectomy - methods
Pancreatic Anastomosis
Pancreatic Fistula
Pancreatic Fistula - etiology
Pancreatic Fistula - surgery
Pancreatic Neoplasms - surgery
Pancreatic Remnant
Pancreatic Resection
Pancreaticojejunostomy - adverse effects
Pancreatitis - etiology
Postoperative Complications - mortality
Postoperative Hemorrhage - etiology
Postoperative Hemorrhage - surgery
Reoperation
Retrospective Studies
Salvage Therapy - methods
Surgery
Thoracic Surgery
Vascular Surgery
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Summary:Background Post-pancreatic surgical morbidity is frequent but often manageable by less invasive means than re-operation. Yet, some complications can become hazardous and life threatening. Herein, the results of a completion pancreatectomy (CP) to cope with severe post-operative pancreatic fistulas (POPF) and bleeding complications after major pancreatic resections for suspected pancreatic malignancy are presented. Methods CPs to treat severe post-pancreatic index-surgery complications between January 2002 and January 2012 were selected out of a prospective database. Indications for CP as well as perioperative data were prospectively collected and retrospectively assessed. Results In 20 of 521 Kausch–Whipple Resections (3.8 %), a CP was necessary to treat post-index surgery morbidity. Indications included insufficiency of the pancreaticojejunal anastomosis with resulting POPF in 14 (70.0 %) patients, severe bleeding complications in 6 (30.0 %) patients, and a severe portal vein thrombosis in 1 (5.0 %) patient. In 7 (35.0 %) of the 20 patients, the course was complicated by remnant pancreatitis. Eleven (55.0 %) of the 20 patients died during the hospital stay. Median time to re-operation did not significantly differ between survivors and in-hospital deaths (10.0 vs. 8.0 days; p  = 0.732). Median hospital stay of the surviving patients was 31.0 (range 10–113) days. Re-operations following CPs were necessary in 5 (55.6 %) of the 9 patients who survived and in 9 (81.8 %) out of 11 patients who died. Conclusions Post-pancreatic resection complications can become hazardous and result in severely ill patients requiring maximum therapy. CP in these cases has a high mortality but serves as an ultima ratio to cope with deleterious complications.
ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-015-2969-9