Abstract
BackgroundReoperation following PD is a surrogate marker for a complex post-operative course and may lead to devastating consequences. We evaluate the indications for early reoperation following PD and analyze its effect on short- and long-term outcome.MethodsFour hundred and thirty-three patients that underwent PD between August 2006 and June 2016 were retrospectively analyzed.ResultsForty-eight patients (11%; ROp group) underwent 60 reoperations within 60 days from PD. Forty-two patients underwent 1 reoperation, and 6 had up to 6 reoperations. The average time to first reoperation was 10.1 ± 13.4 days. The most common indications were anastomotic leaks (22 operations in 18 patients; 37.5% of ROp), followed by post-pancreatectomy hemorrhage (PPH) (14 reoperations in 12 patients; 25%), and wound complications in 10 (20.8%). Patients with cholangiocarcinoma had the highest reoperation rate (25%) followed by ductal adenocarcinoma (12.3%). Reoperation was associated with increased length of hospital stay and a high post-operative mortality of 18.7%, compared to 2.6% for the non-reoperated group. For those who survived the post-operative period, the overall and disease-free survival were not affected by reoperation.ConclusionsEarly reoperations following PD carries a dramatically increased mortality rate, but has no impact on long-term survival.
Highlights
Pancreaticoduodenectomy (PD) is among the most complex and demanding operations
We evaluated the indications for early reoperation following PD and analyzed its effect on short outcome, as well as long-term outcomes of those operated for cancer
The post-operative course including type and timing of complications, management including the usage of interventional radiology, and indications for reoperation, length of hospital stay (LOS), pathology report, adjuvant therapy data, and disease-free and overall survival were evaluated
Summary
Pancreaticoduodenectomy (PD) is among the most complex and demanding operations. Since most patients are operated on for malignancy, one important implication of complex and prolonged post-operative course is failure to reach adjuvant treatment [5, 6]. The impact of reoperation on long-term survival is still unclear [11,12,13]. We evaluated the indications for early reoperation following PD and analyzed its effect on short outcome, as well as long-term outcomes of those operated for cancer. Reoperation following PD is a surrogate marker for a complex post-operative course and may lead to devastating consequences. We evaluate the indications for early reoperation following PD and analyze its effect on short- and long-term outcome
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