The short-term result of distal pancreatectomy with splenic preservation

English version

Abstract

Introduction: The tumor of pancreatic body and tail are relatively rare compared to those of head of pancreas.  Splenic preservation in pancreatic carcinoma’s surgery should be decided on every case. This study to determine the feasibility of distal pancreatectomy with splenic preservation, the rate of early complications of splenectomy surgery to preserve the spleen and the factors: tumor size, tumor location, tumor characteristic to help assess the possibility of preserving the splenic vessels in distal pancreatectomy with splenic preservation.

Methods: retrospective study, case series description for all patients aged 16 years and older with distal pancreatectomy and splenic preservation from 01/01/2012 to 31/12/2017.

Result: We had 47 case of distal pancreatectomy with splenic preservation. There were 26 cases of splenic preservation with preserving the splenic vessels (Kimura technique), 13 cases of splenectomy but not preserving the splenic vessels (Warshaw technique). There were 16 cases of laparoscopic surgery, 31 cases open surgery, general complication in surgery 11 cases. The mean age was 41.13 (17-76 years old). The mean hospital stay was 7.7 days (3 days - 21 days). General complication after surgery in 7 cases, pancreatic fistula in 5 cases, no cases need re-operation, no mortality.

Conclusion: The rate of intraopertative incidence was 23.4%; complications after surgery 14.9%. No case of re-operation or mortality in the study. Factors such as tumor size, tumor location, tumor characteristic did not help assess the possibility of preserving the splenic vessels in of distal pancreatectomy with splenic preservation.

Graphical abstract

Risk factors of short-term complications after pancreaticoduodenectomy treated periampullary carcinomas

English version

Abstract

Introduction: Pancreaticoduodenectomy has been a radical treatment for periampullary carcinoma, which is a collection of malignant neoplasia of the periampullary region. Although the mortality has declined dramatically, the complications are still high. This study aims to determine the occurring rate of short-term complications after pancreaticoduodenectomy and to identify the risk factors related to those complications. Comprehension of these problems help increase the outcome.

Materials and Method: It is a cross-sectional study of the patients with periampullary cancer, who undergo pancreaticoduodenectomy at Cho Ray Hospital from January 2012 to October 2016.

Results: Overall complication rate was 25.65% from 230 patients. In which, pancreatic fistula and surgical site infection were the two most frequent complication (10.43% and 4.38% respectively). Pancreatic fistula was highly significantly associated with Wirsung’s duct diameter less than 3 mm (p = 0.015) and soften pancreatic parenchyma (p = 0.004). The soften pancreatic parenchyma also increased the risk of surgical site infection (OR 4.588), but it was not statistically significant (p = 0.056). Soften pancreatic parenchyma increased the haemorrhage complication significantly (p = 0.04) (OR: 10,668, 95% confidence).

Discussions: Pancreatic main duct’s diameter, pancreatic density and Hemoglobin may relate to the early postoperative complications following pancreaticoduodenectomy. Detailedly, in particular for pancreatic fistula, 2 risk factors recognized are Wirsung’s diameter less than 3mm and soft pancreatic density. Meanwhile low concentration of hemoglobin in blood may increase the risk of incisional infection. Pancreatic density related to the complication of haemorrhage.

Conclusions: Short-term complications’ rate following pancreatoduodenectomy remains high. Understanding the risk factors help us choose which case should be operated and do pre-operative preparation better.

Graphical abstract

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