Outcomes in Early versus Delayed Trauma Pancreaticoduodenectomies in Gunshot Wounds to the Pancreas

Pancreaticoduodenectomy (PD) for traumatic injuries remains a rare procedure with high mortality. This study aims to compare early versus delayed PD in trauma patients with gunshot wound (GSW) injury to the pancreas.

We identified patients in the American College of Surgeons Trauma Quality Improvement Program database (2010-2020) with pancreatic injuries due to GSW undergoing an exploratory laparotomy and a PD. We stratified them into early (≤6 h) and late (>6 h) PD. Hemodynamical instability was defined by shock index (heart rate/systolic blood pressure)>1.0. The primary outcome was in-hospital mortality until discharge, whereas secondary outcomes were hospital length of stay, intensive care unit length of stay, ventilator days, and hospital complications.

A total of 96 patients were included. The median age was 30 y, 91.7% were males, and the median injury severity score was 25. Overall, 64% had early PD and 36% had a late PD. Significantly more liver injuries were observed in the early PD group compared to the late PD group (77.0% versus 51.4%, P = 0.01). The late PD group had a higher percentage of vena cava injuries compared to the early PD group (37.1% versus 18.0%, P = 0.037). The overall mortality was 20.8%. Mortality was higher in early PD compared to late PD (27.8% versus 4.3%, respectively; P = 0.024). Among survivors, patients undergoing late PD had a higher percentage of acute kidney failure compared to those undergoing an early PD (27.3% and 9.3%, respectively; P = 0.039). Early PD is independently associated with increased odds of in-hospital mortality (odds ratio 8.3 [95% confidence interval: 1.62-41.92]).

In this national analysis, delayed PD for GSW to the pancreas following initial stabilization was associated with lower mortality compared to PD performed within 6 h of presentation. These findings support a staged approach when clinically feasible.