Postpancreatectomy hemorrhage (PPH): predictors and management from a prospective database

Area of Science:

• Surgical Oncology
• Gastroenterology
• Hepatobiliary Surgery

Background:

• Postpancreatectomy hemorrhage (PPH) is a significant complication following pancreatic surgery.
• Current therapeutic strategies for PPH lack consensus.
• This study aimed to identify PPH predictors and evaluate treatment approaches.

Purpose of the Study:

• To identify predictors of postpancreatectomy hemorrhage (PPH).
• To assess the therapeutic strategy for PPH.
• To evaluate the impact of PPH on patient outcomes.

Main Methods:

• Prospective data from patients undergoing pancreatectomy between 2005 and 2010 were analyzed.
• The International Study Group Of Pancreatic Surgery (ISGPS) definition was used for PPH diagnosis.
• Multivariate analysis was employed to identify PPH predictors.

Main Results:

• PPH occurred in 16.1% of patients, with grades A, B, and C observed.
• PPH was associated with longer hospital stays, higher mortality (21.7%), and reduced survival.
• Transcatheter arterial embolization (TAE) was the primary interventional treatment, followed by surgery for refractory cases.

Conclusions:

• Age, pancreatic fistula, pancreatoduodenectomy, and nutritional risk index (NRI) are significant risk factors for PPH.
• PPH occurrence markedly increases hospital mortality and decreases survival rates.
• Radiological TAE is a primary treatment, with surgery reserved for treatment failures or hemodynamic instability.