Characteristics of the Gland Remnant Predict Complications after Subtotal Pancreatectomy

Abstract

In 74 patients consecutively operated on with subtotal pancreatectomy (pancreatic duct ligation and no pancreatico-digestive anastomosis) for cancer, we analyzed to what extent size and grade of fibrosis of the gland remnant and the type of cancer (diagnosis), respectively, influenced the risk of early complications after subtotal pancreatectomy. Of the 74 patients 34 (46%) had 52 complications, corresponding to 1.5 complications per patient. Seven patients (9%) needed a reoperation. The 30 days’ mortality was 4% and hospital mortality 5%. The risk of postoperative complications was significantly reduced in the presence of fibrosis of the pancreatic remnant (p < 0.001). There were no intraabdominal complications in the 27 patients who had severe fibrosis. Also, the smaller the pancreatic remnant the less the risk of complications, especially intraabdominal abscesses (p < 0.001). The degree of pancreatic fibrosis was significantly more pronounced in patients with pancreatic cancer than in those with periampullary tumors of other origin (p < 0.005). Intraabdominal complications were more common in patients with other diagnoses than pancreatic cancer (p < 0.05). Pancreatic fistula formation was significantly influenced by the grade of fibrosis of the pancreatic body, but the size of the pancreatic remnant and the tumor origin (diagnosis) was of no importance. Multivariate analysis of factors prognostic for the development of postoperative intraabdominal complications (abscess, bleeding and fistulas) showed that the grade of fibrosis and the size of the pancreatic remnant were independent such factors. The results show that intraabdominal complications after subtotal pancreatectomy are less common in patients with pancreatic cancer than in those with other types of periampullary malignancies. This may partly be explained by the increased degree of fibrosis in the pancreatic remnant in pancreatic cancer which facilitates safe suturing. It was also found that small size of the remnant was accompanied by less morbidity indicating a role of the remaining secretory volume in the development of complications.