Specific Postoperative Complications After Pancreatic Resections - Structure, Predictors, Prevention and Treatment in a Single Institution Series of 173 Cases

Abstract

Introduction: The morbidity rate after pancreatic resections (PR) remains oppressively high and reaches up to 50% in some current studies of world-leading centres and schools. Specific complications are still one of the main problems because they deteriorate the patient`s quality of life, deteriorate the prognosis, prolong the hospital stay and the trеatment expenses exceed by more than 3 times the cost of uncomplicated cases. Aim: The aim of this paper is to conduct an analysis of the early postoperative results after PR and a study on the structure, predictive factors, treatment and prevention of early specific complications. Materials and Methods: A total of 173 PR (135 duodenohemipancreatectomies and 38 left pancreatectomies) have been performed at the authors` institution since January 1, 2007 till December 31, 2015. The study design was single-center, retrospective and randomized. Exclusion criteria were the following: (1) a benign pancreatic disease and/or a neighboring tumor of a different than pancreatic primary site that necessitated PR; (2) R1,2 positive resections; (3) synchronous 1-metastases, i.e. single-stage multivisceral resections; (4) age ≥ 70 years; (5) the presence of ≥ 3 comorbid conditions. Finally, we selected 108 cases and collected and analyzed perioperative data, specific characteristics of the procedure (duration, blood loss, technical aspects of the anastomosis, protective drainages) and the early postoperative results. Results: The early (within 30 days after surgery) mortality and specific morbidity rates were 3.7% (4 cases) and 31.5% (42 complications in 34 patients), respectively. Reoperation was indicated in 3 cases (2.8%) while the remaining 31 patients were treated conservatively and/or by interventional procedures. We performed correlative analyses for dependence between: (1) mortality and specific morbidity rates on the one hand and (2.1.) preoperative condition, respectively adequate preparation, and jaundice cure on the other; (2.2.) type and technique of anastomoses; (2.3.) pancreatic duct diameter; (2.4.) quantity of operative blood loss. Conclusion: In our series of right and left PR we found prognostic value of the preoperative patient`s condition, anastomosis construction and operative blood loss for a specific morbidity