Cephalic duodenopancreatectomy resection: technique, morbidity and mortality

Abstract

Background: Advances in recent decades in the massive form of diagnostic techniques for images, a better understanding of pancreatic diseases and management pre, intra, and postoperative patients has affected in some centres of reference, a significant reduction of mortality and an increase in the survival of the cephalic pancreaticoduodenectomy for the treatment of malignant and benign tumours of the confluent bile-duodenum-pancreatic today this surgery is performed with acceptable morbidity and mortality. The objective of this study is to evaluate the incidence of the disease, pancreatic resection technique, morbidity and mortality of the Pancreaticoduodenectomy. Methods: Between December 2000 and December 2014, 96 PDC have been operated. Of them, 54 male and 42 female, whose ages ranged from 27 to 79 years old (average of 59 years) In relation of symptoms, in 89 patients had weight loss which varied between 4 to 15 kg, 83 opportunities presented jaundice, in 82 cases looked for pain, 51 vomiting and fever in 14 cases. All the patients out an ultrasound of the abdomen, to detect 80 times allowed observing tumours, noting in addition in 82 cases the main bile duct dilatation. Likewise, was performed in all patients a CT scan of the abdomen, which showed in 86 opportunities dilatation of Wirsung duct and 89 cases bile duct dilatation hepatic intra and extra hepatic. Results: All patients underwent a PD and as it is our custom, trying to expand the pancreatic resection as much as possible to the left of the mesenteric-portal axis in patients with tumours of the head of pancreas and lymphadenectomy in the hepatic pedicle prolonged by the artery to the celiac trunk. In addition, we have extended lymphadenectomy to the superior mesenteric artery and tissue retro-portal. We rebuild by pancreatic-jejunostomy term-terminal invagination anastomosis with a tutor in the Wirsung duct in cases of pancreas mild. 10-15 cm from it makes the hepatico-jejunostomy anastomosis end-side. About 40 cm of pancreatic-jejunostomy anastomosis jejunum is sectioned to make a Y -shaped Roux, whose distal sector, previous close terminal, allow the gastro-jejunostomy With respect to mortality within 30 days, 5 patients (4, 80%) died. Subsequently, 5 more patients died within 90 days (9.3%). With respect to morbidity, we divide them into in two, clinics that were 17 patients (16.32%), which were 3 lung disease, 6 febrile syndromes, 4 diabetes, 1 arrhythmia, 1 IAM, respiratory failure and an atrial fibrillation last two died. 50 patients were surgical (48%). Within pancreatic fistula was in 32 patients (30, 72%), divided into type A: in 25 cases (24%) where there was no clinical impact, type B: 4 opportunities (3.84%) and finally type C: 3 (2.88%), which one of them after being intervened. C patient died. With respect to the gastric emptying was present in 19 (18.24%) who had more than 10 days the SNG. Finally 5 (4.80%) had intra peritoneal bleeding, which were re intervened and one of them died. In addition, 8 patients had a biliary fistula (7.62%). Conclusion: Finally, we would like to talk about strong evidence that high-volume centres have lower mortality than low-volume centres. There is evidence that patients treated at high-volume centres have reduced surgical mortality and morbidity, higher survival in the long term, greater number of lymph nodes in the surgical specimen, increased frequency of R0, less hospital stay, and generate lower costs. The Results of our work support the concept that surgeons with low volume of PDC annually, but with strict training in institutions with adequate infrastructure and a multidisciplinary team, can also get good results in the malignant and benign lesions of biliary-duodenum-pancreatic confluent.