Vascular complications associated with pancreaticoduodenectomy adversely affect clinical outcome.
BACKGROUND
Early survival after pancreaticoduodenectomy has improved, but its morbidity remains high. The purpose of this study is to determine how the intra-operative (OR) occurrence of major vascular complications affects the outcome of pancreaticoduodenectomy.


METHODS
The medical records of 180 consecutive patients having pancreaticoduodenectomy from 1991 to 2001 were reviewed. Vascular complications were defined as "an unanticipated injury or thrombosis of a major vessel necessitating intervention." Age, sex, type of pancreaticoduodenectomy, tumor size, estimated blood loss, OR time, time in intensive care, post-OR hospitalization, and survival were compared.


RESULTS
Eighteen vascular complications were identified. Differences in age, sex, and type of resection between patients with or without vascular complications were not significant. OR time, estimated blood loss, blood transfusions, tumor size, time in intensive care, and post-OR hospitalization were all significantly greater in patients with vascular complications. Median survival for patients with vascular complications was significantly shorter than for patients without vascular complications. Thirty-day mortality was greater in patients with vascular complications.


CONCLUSIONS
Vascular complications significantly affect the outcome of pancreaticoduodenectomy increasing OR time, estimated blood loss, blood transfusion requirements, time in intensive care, post-OR hospitalization, and mortality.
Kim
Anthony W
AW
Departments of General and Cardiovascular Thoracic Surgery, Rush Presbyterian-St. Luke's Medical Center, Chicago, Ill 60612, USA.
McCarthy
Walter J
WJ
Maxhimer
Justin B
JB
Quiros
Roderick M
RM
Hollinger
Edward F
EF
Doolas
Alexander
A
Millikan
Keith W
KW
Deziel
Daniel J
DJ
Godellas
Constantine V
CV
Prinz
Richard A
RA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D010195:Pancreatitis / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000209:etiology* / Q000401:mortality / Q000628:therapy