Salvage Completion Pancreatectomies as Damage Control for Post-pancreatic Surgery Complications: A Single-Center Retrospective Analysis

• Published in: World journal of surgery Vol. 39; no. 6; pp. 1550 - 1556
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.06.2015; Springer Nature B.V
• Subjects: Abdominal Surgery; Aged; Aged, 80 and over; Anastomotic Insufficiency; Anastomotic Leak - etiology; Anastomotic Leak - surgery; Cardiac Surgery; Female; General Surgery; Hospital Mortality; Humans; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Original Scientific Report; Pancreas - surgery; Pancreatectomy - adverse effects; Pancreatectomy - methods; Pancreatic Anastomosis; Pancreatic Fistula; Pancreatic Fistula - etiology; Pancreatic Fistula - surgery; Pancreatic Neoplasms - surgery; Pancreatic Remnant; Pancreatic Resection; Pancreaticojejunostomy - adverse effects; Pancreatitis - etiology; Postoperative Complications - mortality; Postoperative Hemorrhage - etiology; Postoperative Hemorrhage - surgery; Reoperation; Retrospective Studies; Salvage Therapy - methods; Surgery; Thoracic Surgery; Vascular Surgery; Pancreatic Remnant; Pancreatic Anastomosis; Pancreatic Fistula; Pancreatic Resection; Anastomotic Insufficiency
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-015-2969-9

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.