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Zero mortality after 152 consecutive pancreaticoduodenectomies with pancreaticogastrostomy
Gerard V Aranha1, Pamela J Hodul, Steven Creech
1Section of Surgical Oncology, Hines VA Hospital, Maywood, IL 60153, USA.
Background:
Since 1968, there have been three published reports in the United States literature of 41, 118, and 145 consecutive patients undergoing pancreaticoduodenectomy without mortality. In all of these series, the pancreatic remnant was anastomosed to the jejunum.
Study Design:
This study was designed to review 152 consecutive patients who underwent pancreaticoduodenectomy in whom the pancreatic remnant was anastomosed to the stomach (pancreaticogastrostomy).
Results:
A total of 152 patients underwent pancreaticoduodenectomy with pancreaticogastrostomy between July 1992 and May 2002. There were 85 men and 67 women with a mean age of 65.7 years (range 31 to 90 years). Of the patients, 87 were less than 69 years of age and 65 were more than 69 years. A total of 114 patients had a malignant neoplasm and the remaining 38 had either cystic neoplasms or benign disease. When the two groups were compared, the patients who were more than 69 years of age had a significantly high incidence of hypertension, previous cancer, atrial fibrillation, and coronary artery disease. In addition, patients more than 69 years of age had a significantly high incidence of jaundice and placement of preoperative stents. Patients more than 69 years of age had significantly less operative time but there was no between-group difference in estimated blood loss, transfusion, number of units transfused, and postoperative length of stay. There was no postoperative mortality [corrected] in this series. Pancreatic leak and fistulae were the most common complications, followed by intraabdominal abscess, wound infection, and delayed gastric emptying.
Conclusions:
In this study, 152 consecutive patients underwent pancreaticoduodenectomy with pancreaticogastrostomy without postoperative mortality. Morbidity was mostly because of pancreatic leaks and fistulae, which were successfully treated nonoperatively. With proper selection, careful preoperative preparation, and proper intraoperative conduct of operation, the Whipple procedure can be performed without postoperative mortality.
Insights
Pancreaticoduodenectomy with pancreaticogastrostomy achieved zero postoperative mortality in 152 patients. Complications like pancreatic leaks were managed nonoperatively, demonstrating the Whipple procedure
Area of Science:
- Surgical Oncology
- Gastroenterology
- Hepatobiliary Surgery
Background:
- Previous pancreaticoduodenectomy series reported zero mortality with pancreaticojejunostomy.
- The pancreatic remnant was anastomosed to the jejunum in prior studies.
Purpose of the Study:
- To review 152 consecutive pancreaticoduodenectomy patients.
- To evaluate outcomes when the pancreatic remnant was anastomosed to the stomach (pancreaticogastrostomy).
Main Methods:
- Retrospective review of 152 patients undergoing pancreaticoduodenectomy with pancreaticogastrostomy.
- Data collected between July 1992 and May 2002.
- Comparison of outcomes between patients younger and older than 69 years.
Main Results:
- No postoperative mortality was observed in the 152 patients.
- Pancreatic leaks and fistulae were the most frequent complications, treated nonoperatively.
- Older patients (>69 years) showed higher rates of comorbidities and preoperative jaundice but similar operative times and lengths of stay.
Conclusions:
- Pancreaticoduodenectomy with pancreaticogastrostomy can be performed without postoperative mortality.
- Careful patient selection and surgical conduct are crucial for successful outcomes.
- Pancreatic leaks and fistulae are manageable complications.