Background: Pancreaticoduodenectomy in the modern era is generally a safe operation for lesions of the pancreatic head. Still, complications are common but not often thoroughly reported. We sought to review our experience with pancreaticoduodenectomy (PD) to focus on predictors of postoperative complications and mortality.
Methods: After approval by the institutional review board, the clinicopathologic records of 309 consecutive patients undergoing PD between 1992 and 2006 were reviewed. Patients with significant postoperative complications were identified and compared by Student’s T-test or Fisher’s Exact test, where appropriate. Kaplan-Meier survival curves were constructed and compared by Log-rank analysis.
Results: PD was undertaken for periampullary cancers in 226 (73%), neuroendocrine carcinoma (NEC) in 26 (8%), chronic pancreatitis in 49 (16%), and other benign tumors in 8 (3%). Pylorus preservation was undertaken in 33% and pancreatic reconstruction was completed in a duct-to-mucosa fashion in 88%. Median length of stay was 12 days (range 5 - 49). Complications occurred in 44% including infectious complications 17%, pulmonary 7%, pancreatic fistula 8%, delayed gastric emptying 9%, and hemorrhage 7%. Postoperative mortality was 4.5%. Compared to patients with uneventful postoperative courses, patients with complications were similar in terms of age, gender, comorbidities, preoperative biliary stenting, pylorus preservation, tumor size, and type. Surprisingly, length of hospitalization was not significantly impacted by the presence of complications (median 15 days vs. 12). Median survival for periampullary malignancies was 21.7 months, 139.7 months for NEC, and was not reached in patients with benign diseases. Overall survival was not different in patients with and without perioperative complications regardless of the final pathology.
Conclusions: Perioperative complications following pancreaticoduodenectomy are common but rarely life-threatening. After recovery, patients suffering complications can expect long-term survival similar to those in which no complications occurred.