Morbidity after pancreatic resection

Abstract

Dear Editor: With great interest we read the results of a prospective randomized trial comparing organ-preserving pancreatic head resection with pylorus-preserving pancreaticoduodenectomy, recently published in Langenbeck’s Archives of Surgery [1]. Farkas and Coworkers demonstrate that organpreserving pancreatic head resection is superior to pyloruspreserving pancreaticoduodenectomy in patients with chronic pancreatitis. The most interesting finding, however, is that for the first time to our knowledge a substantial number of pancreatic head resections were carried out without mortality and particularly without any morbidity at all. Data from hospitals with a high case load of pancreatic surgery all over the world have demonstrated a decrease in hospital mortality to less than 5% and even less than 3% [2–4]. On the other hand, morbidity after pancreatic resection still remains high with complication rates between 20 and 50% if a meticulous analysis of all medical as well as surgical complications is carried out. Such surgical complications include delayed gastric emptying, septic complications including wound infection and intra-abdominal abscesses, pancreatic, biliary or colonic fistula, postoperative haemorrhage, as well as postoperative ileus or paralysis. Beyond these more common adverse events, there are rarer complications such as liver necrosis, cholangitis, and chyloascites. The medical complications typically encountered after pancreatic head resection comprise cardiopulmonary, renal, neurologic as well as cathetersepsis-related problems [2–11]. Therefore, there is some concern that not all potential complications were prospectively recorded in the analysis by Farkas and co-workers. A possible explanation may be that only the three complications presented, as given in Table 2 (delayed gastric emptying, pulmonary complication and re-laparotomy), were actually recorded. Still, even if only these factors were documented, a zero morbidity in a larger series of pancreatic head resection remains remarkable and will probably not be reproducible, even in other high case load centers of excellence. We would kindly ask the authors to clarify exactly which of the potential morbidity factors were specifically recorded in their study to allow better conclusions for the busy pancreatic surgeons around the world that still struggle with regular postoperative morbidity.