Postoperative complications of pancreatic cancer surgery

The incidence of ductal adenocarcinoma of the pancreas has been increasing worldwide in recent years. About 5% to 25% of all pancreatic cancers are resectable and only curatively resected patients enjoy a favourable outcome. But even in experienced centers a postoperative morbidity of 30-50% and a mortality around or underneath 5% is reported. As long term-survival is rare and complications are frequent the quality of life for the remaining months or years is of paramount importance. The most severe complications lead to reoperations, prolonged hospital stay, fatigue, and nutritional disorders thereby markedly compromising quality of life. Therefore, prevention and management of complications after pancreatic resections are reviewed. Prevention of disastrous complications is possible using a decent surgical technique and handling the soft pancreatic remnant in cancer patients carefully. The end-to-side, duct-to-mucosa anastomosis is the most preferred technique. The therapy of pancreatic leakage should be individualized and completion pancreatectomy should only be an option for recurrent hemorrhage, and a necrotic pancreatic stump. The continuous postoperative observation of the patient is of paramount importance to diagnose other severe complications, such as hemorrhage and septic complications, in time. Only early diagnosis and management of these complications can improve outcome and save life. Pancreaticoduodenectomy can be a safe procedure in experienced institutions, where the whole medical team is able to diagnose and treat these complications at any time.