Oesophagogastrectomy and pancreatoduodenectomy for caustic injury

The justification for pancreatoduodenectomy (PD) for extended duodenal and pancreatic caustic necrosis is still a matter of debate.

This was a retrospective evaluation of patients who underwent PD in association with oesophagogastrectomy from a large single-centre cohort of patients with caustic injuries. Morbidity, mortality and long-term outcome were assessed.

PD was performed in 18 (6·6 per cent) of 273 patients who underwent emergency surgery for caustic injuries. Biliary and pancreatic duct reconstruction during PD was performed in ten and six patients respectively. Seven patients died and 17 experienced operative complications after PD for caustic injuries. Twelve patients required at least one reoperation. Specific PD-related complications occurred in 13 patients. Initial (P = 0·038) or secondary (P < 0·001) extension of necrosis to adjacent organs were independent predictors of operative death. After a median follow-up of 24 months following reconstruction, three patients had recovered nutritional autonomy. In an intention-to-treat analysis, functional success was recorded in three patients and the 5-year survival rate was 39 per cent after PD for caustic injury.

PD can save the lives of patients with caustic injuries extending beyond the pylorus, but has poor functional outcome. Immediate pancreatic duct reconstruction should be preferred to duct occlusion to decrease the rate of pancreatic complications.