Korean J Hepatobiliary Pancreat Surg.  2016 Feb;20(1):23-31. 10.14701/kjhbps.2016.20.1.23.

Postoperative biological and clinical outcomes following uncomplicated pancreaticoduodenectomy

Affiliations
  • 1Service de Chirurgie digestive, Hopital universitaire d'Angers - Universite d'Angers, France.
  • 2Digestive surgery, Hospital of Kunming - Medical University - Kunming - China.
  • 3Service de Chirurgie Hepatobiliopancreatique, Hopital Beaujon - Universite Paris VII, France.
  • 4Service de Chirurgie digestive et oncologique, Hopital Claude Huriez - Universite de Lille, France.
  • 5Service de Chirurgie generale et digestive, Hopital Saint-antoine - UPMC Paris VI, France.
  • 6Service de Chirurgie digestive et de transplantation, Hopital Rangueil - Universite de Toulouse, France.
  • 7Service de Chirurgie digestive, Hopital Haut Leveque - Universite de Bordeaux, France.
  • 8Service de Chirurgie digestive, Hopital de la Timone - Universite de Marseille, France.
  • 9Unite de Chirurgie Hepatobiliaire et Pancreatique, Nouvel Hopital Civil, Universite de Strasbourg, IHU MixSurg, IRCAD, France. patrick.pessaux@chru-strasbourg.fr

Abstract

BACKGROUNDS/AIMS
The aim of this study was to describe clinical and biological changes in a group of patients who underwent pancreaticoduodenectomy (PD) without any complication during the postoperative period. These changes reflect the "natural history" of PD, and a deviation should be considered as a warning sign.
METHODS
Between January 2000 and December 2009, 131 patients underwent PD. We prospectively collected and retrospectively analyzed demographic data, pathological variables, associated pathological conditions, and preoperative, intraoperative, and postoperative variables. Postoperative variables were validated using an external prospective database of 158 patients.
RESULTS
The mean postoperative length of hospital stay was 20.3+/-4 days. The mean number of days until removal of nasogastric tube was 6.3+/-1.6 days. The maximal fall in hemoglobin level occurred on day 3 and began to increase after postoperative day (POD) 5, in patients with or without transfusions. The white blood cell count increased on POD 1 and persisted until POD 7. There was a marked rise in aminotransferase levels at POD 3. The peak was significantly higher in patients with hepatic pedicle occlusion (866+/-236 IU/L versus 146+/-48 IU/L; p<0.001). For both gamma-glutamyl transpeptidase and alkaline phosphatase, there was a fall on POD1, which persisted until POD 5, followed with a stabilization. Bilirubin decreased progressively from POD 1 onwards.
CONCLUSIONS
This study facilitates a standardized biological and clinical pathway of follow-up. Patients who do not follow this recovery indicator could be at risk of complications and additional exams should be made to prevent consequences of such complications.

Keyword

Pancreaticoduodenectomy; Complication; Natural history; Biological test

MeSH Terms

Alkaline Phosphatase
Bilirubin
Critical Pathways
Follow-Up Studies
gamma-Glutamyltransferase
Humans
Length of Stay
Leukocyte Count
Natural History
Pancreaticoduodenectomy*
Postoperative Period
Prospective Studies
Retrospective Studies
Alkaline Phosphatase
Bilirubin
gamma-Glutamyltransferase

Figure

  • Fig. 1 Mean daily output in the nasogastric tube.

  • Fig. 2 Mean daily output in the left drain.

  • Fig. 3 Mean hemoglobin level per day.


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