Early postoperative complications after (sub)total pancreatoduodenectomy: the AMC experience

The postoperative course is described in 70 patients who underwent pancreatic resection for a tumor of the head of the pancreas and peri-ampullary region: 64 patients had malignant disease. Subtotal pancreatoduodenectomy was carried out in 52 patients and total pancreatoduodenectomy in 18 patients. The overall 30-day mortality was 4.3% (3 patients died: one after subtotal, 2 after total pancreatoduodenectomy). Major complications required surgical reintervention in 15 patients. Another 24 patients developed minor complications, and responded well to conservative treatment. Infective complications were the main cause of post-operative morbidity, occurring in 29 patients. Dehiscence of the pancreatico-jejunostomy required surgical reintervention in one patient. This patient died. Leakage of the pancreatico-jejunostomy was radiologically demonstrated in 10 other patients. Four of these 10 patients presented with clinical symptoms: one needed surgical intervention and 3 responded to conservative management. The results of this study confirm the present trend of decreasing mortality after pancreatoduodenectomy. Postoperative morbidity remains high. Usually, leakage of the pancreatic anastomosis was not associated with serious postoperative complications and subsided without the need of treatment in the majority of cases.