Abstracts
2002 Digestive Disease Week

# 100570 Abstract ID: 100570 Complex Pancreatic Surgery: The Role of Interventional Radiologists in Managing Patients and Complications
Taylor A Sohn, Charles J Yeo, John L Cameron, Keith D Lillemoe, Jeffrey F Geschwind, Sally E Mitchell, Anthony C Venbrux, Baltimore, MD

Background: While the mortality rate following pancreaticoduodenectomy (PD) has decreased, the morbidity rate remains high. Major morbidity is often managed with the aid of interventional radiologists. Objective: To evaluate the cooperative roles of the interventional radiologists and pancreatic surgeons in pancreatic surgery, specifically PD. Methods: Our PD database was reviewed for all patients undergoing PD between January 1, 1995 and December 31, 2000. The interventional radiologic procedures for each patient were evaluated. Results: 1061 patients underwent PD. The overall mortality and morbidity rates were 2.3% and 35%, respectively. 471 patients (44%) had interventional radiologic procedures. 342 (32%) had only preop percutaneous biliary drainage (PBD) and 129 (12%) required postop intervention. 590 patients (56%) had no interventional radiologic procedures. Percutaneous aspiration/catheter drainage was required in 84 patients for intraabdominal abscess, biloma, or lymphocele, with 24 requiring two or more abscess drains. 39 patients had postop PBD for a bile leak due to anastomotic disruption, undrained biliary segments, or t-tube/bile stent dislodgment. 18 patients had hemobilia/GI bleeding treated by angiography with embolization. The reoperation rate was 4.1% (n=43). Only 19 of the 129 patients requiring postop interventional radiology required reoperation. Only 6 of 18 patients requiring embolization for bleeding required surgical intervention for the same reason, while 9 of 84 patients undergoing abscess drainage required operation for anastomotic disruption or unsuccessful percutaneous drainage. The postop length of stay (LOS) was 27 days for patients needing reoperation. The postop complications and LOS for patients requiring or not requiring postop interventional radiologic (IR) procedures are shown in the table. Conclusions: Interventional radiologists play a critical role in the management of some patients undergoing PD. While complications such as anastomotic leaks, abscess formation, and bleeding increase mortality and LOS, the skills of the interventional radiology team provide less invasive management of such life threatening complications, avoiding reoperation, improving recovery times and minimizing morbidity.