A Clinical Analysis on the Pancreaticoduodenectomy

Lee, Sang Woon; Kim, Tae Hyun; Choi, Young Kil; Paik, Nak Whan

Abstract

BACKGROUND/AIMS: During the past several decades pancreaticoduodenectomy has carried a tremendous operative risk. Recently, however, mortality has decreased markedly to around 5%. The aim of this study was to determine the indication, clinical course and complications for the procedure. We also assessed the risk factors of operative morbidity and mortality.
METHODS
During the period from June 1979 to July 1998, 155 patients underwent pancreaticoduodenectomy at our institution. The clinical records and pathologic reports were reviewed retrospectively.
RESULTS
There were 102 men and 53 women. Mean age was 55.5 years. Indications for the procedure were periampullary carcinoma in 121 patients(78.1%), other malignant tumors in 13 patients(8.2%), and benign diseases including trauma in 21 patients(13.5%). A standard pancreaticoduodenectomy was performed in 113 patients. The remaining 42 patients underwent pylorus preserving pancreaticoduodenectomy. Operative morbidity occurred in 46 patients (29.7%). Pancreatic fistula was the most common complication (11.0%). There were nine operative deaths(5.8%). For the patients with pancreatic fistula, the mortality rate was 41.1%. Patient's age, serum albumin, serum bilirubin, hemoglobin, and leucocyte count had no significant influences on the result of operation. Type of procedure, operation time, amount of transfusion, or use of octreotide were not determining factors for operative mortality.
CONCLUSIONS
Pancreaticoduodenectomy was performed in 155 patients with a mortality of 5.8% and a morbidity of 29.7%. The main cause of operative death was pancreatic fistula. There were no specific contributing factors leading to operative morbidity and mortality. It is suggested that technical precision and gentleness are of great importance for patients undergoing pancreaticoduodenectomy