Salvage Completion Pancreatectomies as Damage Control for Post-pancreatic Surgery Complications: A Single-Center Retrospective Analysis
Standard
Salvage Completion Pancreatectomies as Damage Control for Post-pancreatic Surgery Complications: A Single-Center Retrospective Analysis. / Nentwich, Michael F; El Gammal, Alexander T; Lemcke, Torben; Ghadban, Tarik; Bellon, Eugen; Melling, Nathaniel; Bachmann, Kai; Reeh, Matthias; Uzunoglu, Faik G; Izbicki, Jakob R; Bockhorn, Maximilian.
in: WORLD J SURG, Jahrgang 39, Nr. 6, 06.2015, S. 1550-6.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Salvage Completion Pancreatectomies as Damage Control for Post-pancreatic Surgery Complications: A Single-Center Retrospective Analysis
AU - Nentwich, Michael F
AU - El Gammal, Alexander T
AU - Lemcke, Torben
AU - Ghadban, Tarik
AU - Bellon, Eugen
AU - Melling, Nathaniel
AU - Bachmann, Kai
AU - Reeh, Matthias
AU - Uzunoglu, Faik G
AU - Izbicki, Jakob R
AU - Bockhorn, Maximilian
PY - 2015/6
Y1 - 2015/6
N2 - BACKGROUND: Post-pancreatic surgical morbidity is frequent but often manageable by less invasive means than re-operation. Yet, some complications can become hazardous and life threatening. Herein, the results of a completion pancreatectomy (CP) to cope with severe post-operative pancreatic fistulas (POPF) and bleeding complications after major pancreatic resections for suspected pancreatic malignancy are presented.METHODS: CPs to treat severe post-pancreatic index-surgery complications between January 2002 and January 2012 were selected out of a prospective database. Indications for CP as well as perioperative data were prospectively collected and retrospectively assessed.RESULTS: In 20 of 521 Kausch-Whipple Resections (3.8%), a CP was necessary to treat post-index surgery morbidity. Indications included insufficiency of the pancreaticojejunal anastomosis with resulting POPF in 14 (70.0%) patients, severe bleeding complications in 6 (30.0%) patients, and a severe portal vein thrombosis in 1 (5.0%) patient. In 7 (35.0%) of the 20 patients, the course was complicated by remnant pancreatitis. Eleven (55.0%) of the 20 patients died during the hospital stay. Median time to re-operation did not significantly differ between survivors and in-hospital deaths (10.0 vs. 8.0 days; p = 0.732). Median hospital stay of the surviving patients was 31.0 (range 10-113) days. Re-operations following CPs were necessary in 5 (55.6%) of the 9 patients who survived and in 9 (81.8%) out of 11 patients who died.CONCLUSIONS: Post-pancreatic resection complications can become hazardous and result in severely ill patients requiring maximum therapy. CP in these cases has a high mortality but serves as an ultima ratio to cope with deleterious complications.
AB - BACKGROUND: Post-pancreatic surgical morbidity is frequent but often manageable by less invasive means than re-operation. Yet, some complications can become hazardous and life threatening. Herein, the results of a completion pancreatectomy (CP) to cope with severe post-operative pancreatic fistulas (POPF) and bleeding complications after major pancreatic resections for suspected pancreatic malignancy are presented.METHODS: CPs to treat severe post-pancreatic index-surgery complications between January 2002 and January 2012 were selected out of a prospective database. Indications for CP as well as perioperative data were prospectively collected and retrospectively assessed.RESULTS: In 20 of 521 Kausch-Whipple Resections (3.8%), a CP was necessary to treat post-index surgery morbidity. Indications included insufficiency of the pancreaticojejunal anastomosis with resulting POPF in 14 (70.0%) patients, severe bleeding complications in 6 (30.0%) patients, and a severe portal vein thrombosis in 1 (5.0%) patient. In 7 (35.0%) of the 20 patients, the course was complicated by remnant pancreatitis. Eleven (55.0%) of the 20 patients died during the hospital stay. Median time to re-operation did not significantly differ between survivors and in-hospital deaths (10.0 vs. 8.0 days; p = 0.732). Median hospital stay of the surviving patients was 31.0 (range 10-113) days. Re-operations following CPs were necessary in 5 (55.6%) of the 9 patients who survived and in 9 (81.8%) out of 11 patients who died.CONCLUSIONS: Post-pancreatic resection complications can become hazardous and result in severely ill patients requiring maximum therapy. CP in these cases has a high mortality but serves as an ultima ratio to cope with deleterious complications.
KW - Aged
KW - Aged, 80 and over
KW - Anastomotic Leak
KW - Female
KW - Hospital Mortality
KW - Humans
KW - Length of Stay
KW - Male
KW - Middle Aged
KW - Pancreas
KW - Pancreatectomy
KW - Pancreatic Fistula
KW - Pancreatic Neoplasms
KW - Pancreaticojejunostomy
KW - Pancreatitis
KW - Postoperative Complications
KW - Postoperative Hemorrhage
KW - Reoperation
KW - Retrospective Studies
KW - Salvage Therapy
U2 - 10.1007/s00268-015-2969-9
DO - 10.1007/s00268-015-2969-9
M3 - SCORING: Journal article
C2 - 25651954
VL - 39
SP - 1550
EP - 1556
JO - WORLD J SURG
JF - WORLD J SURG
SN - 0364-2313
IS - 6
ER -