Pancreaticoduodenectomy — results and prospects (two-center study)

Solodkiy VA, Kriger AG, Gorin DS, et al. . Pancreaticoduodenectomy — results and prospects (two-center study). Pirogov Russian Journal of Surgery. 2023;(5):13‑21. (In Russ.)
https://doi.org/10.17116/hirurgia202305113

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)

Использование инфографики авторами научных работ

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OBJECTIVE

To summarize the results of pancreaticoduodenectomy (PD) for pancreatic tumors and complications of chronic pancreatitis regarding prediction and prevention of postoperative complications.

MATERIAL AND METHODS

There were 336 PD procedures between 2016 and mid-2022 in two centers. We assessed the factors influencing specific postoperative complications (postoperative pancreatitis, pancreatic fistula, gastric stasis, arrosive bleeding). Several risk factors were distinguished: baseline pancreatic disease and tumor size, CT-signs of a «soft» gland, intraoperative assessment of the pancreas, number of functioning acinar structures. We assessed surgical prevention of pancreatic fistula via preserving adequate blood supply to the pancreatic stump. The last one is provided by extended pancreatic resection and reconstructive stage of surgery, i.e. Roux-en-Y hepatico- and duodenojejunostomy with isolation of pancreaticojejunostomy on the second loop.

RESULTS

Postoperative pancreatitis underlies specific complications after PD. The risk of pancreatic fistula in case of postoperative pancreatitis increases by 5.3 times compared to patients without pancreatitis. Postoperative pancreatic fistula is more common in patients with T1 and T2 tumors. According to univariate analysis, only pancreatic fistula significantly affects the risk of gastric stasis. Among 336 people who underwent PD, pancreatic fistula occurred in 69 patients (20.5%), gastric stasis — in 61 (18.2%), pancreatic fistula complicated by arrosive bleeding — in 45 (13.4%) patients. Mortality rate was 3.6% (n=15).

CONCLUSION

Modern prognostic criteria are valuable to predict specific complications after PD. A promising way to prevent postoperative pancreatitis can be extended pancreatic resection considering angioarchitectonics of the pancreatic stump. Roux-en-Y pancreaticojejunostomy is advisable to reduce aggressiveness of pancreatic fistula.

Keywords:

pancreaticododenectomy

postoperative pancreatitis

pancreatic fistula

gastric stasis

prognosis

prevention

Authors:

Solodkiy V.A.

Russian Research Center of Radiology

SPIN RSCI: 440543
Scopus AuthorID: 57204298158
ResearcherID: T-6803-2017
ORCID: 0000-0002-1641-6452

Kriger A.G.

Russian Research Center of Radiology;
Russian Medical Academy of Postgraduate Education

ORCID: 0000-0002-4567-8312

Gorin D.S.

National Medical Research Center of Surgery named after A.V. Vishnevsky of Ministry of health of the Russian Federation

SPIN RSCI: 4284-4275
Scopus AuthorID: 35299202200
ORCID: 0000-0002-6452-4458

Dvukhzhilov M.V.

Vishnevsky National Medical Research Center of Surgery

ORCID: 0000-0001-7283-7465

Akhaladze G.G.

Russian Research Center for Radiology

SPIN RSCI: 4598-8148
Scopus AuthorID: 6603298862
ORCID: 0000-0002-5011-4853

Goncharov S.V.

Russian Scientific Center of Roentgenoradiology

SPIN RSCI: 2722-7264
Scopus AuthorID: 57204090222
ORCID: 0000-0001-7914-1882

Panteleev V.I.

Russian Research Center of Radiology

ORCID: 0000-0002-1575-1267

Shuinova E.A.

Russian Scientific Center of Roentgenoradiology

SPIN RSCI: 7069-7294
Scopus AuthorID: 57204099243
ORCID: 0000-0003-4148-9394

Received:

26.09.2022

Accepted:

02.10.2022

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