Pancreatic head resection: the risk for local and systemic complications in 1315 patients - a monoinstitutional experience

Pancreatic head resection is a major surgical procedure and even today is linked to considerable risk for severe complications. In high-volume centers, morbidity and mortality after pancreatic head resection decreased to below 5%. In the authors' monoinstitutional experiences including 1315 patients with malignant lesion and benign tumor, the frequency and severity of local as well as systemic complications after pancreatic head resection are reported. Between 1982 and 2004, 1315 patients underwent several types of pancreatic head resections including 549 patients with periampullary cancer, 57 with cystic neoplastic lesions, 61 with neoplasia of the papilla, 18 with endocrine tumors, and 630 with inflammatory head tumors in chronic pancreatitis. Kausch-Whipple resection was applied in 208 patients, pylorus-preserving pancreatic head resection in 412, duodenum-preserving pancreatic head resection in 571, total pancreatectomy in 36, and ampullectomy in 61 patients. Pancreatic fistula was observed in 6.8% and a breakdown of pancreaticojejunostomosis in 2.5% of the patients. Gastrointestinal leakage occurred in 0.5%. Pancreatic fistula was managed nonsurgically in 84 of 89 patients. However, the breakdown of pancreatic anastomosis requiring completion pancreatectomy developed in 29 of 33 patients. The hospital mortality of the breakdown of pancreaticojejunostomosis rose up to 34.5%; hospital mortality in patients with pancreatic fistula was 3.6%. The total hospital mortality in 1315 patients after head resection was 2.05%. Risk factors with significant relation to outcome criteria on nonsurvival are the breakdown of pancreaticojejunostomosis, severe intra-abdominal bleeding, intra-abdominal abscess, and postoperative multiorgan dysfunction syndrome. Pancreatic fistula as well as biliary leakage did not significantly determine outcome. Pancreatic head resection for neoplastic and benign tumor lesions of the pancreatic head using different resection techniques is still a major surgical procedure but with a low risk for severe complications in a high-volume center. Pancreatic fistula is a local complication that results in a prolongation of hospital stay but does not contribute to mortality and reoperation. However, the breakdown of pancreaticojejunostomosis is a life-threatening complication causing abdominal sepsis. (C) 2007 Excerpta Medica Inc. All rights reserved.