[Surgical treatment of pancreatic adenocarcinoma by cephalic duodenopancreatectomy (Part 1). Post-surgical complications in 204 cases in a reference hospital].
BACKGROUND
Cephalic duodenopancreatectomy (CDP) is the treatment of choice in cancer of the head of the pancreas. However, it continues to have a high post-surgical morbidity and mortality. The aim of this article is to define variables that influence post-surgical morbidity and mortality after cephalic duodenopancreatectomy due to pancreatic adenocarcinoma (PA) cancer of the head of the pancreas (CHP).


METHODS
The variables were prospectively collected form patients operated on between 1991 and 2007, in order to investigate the factors of higher morbidity.


RESULTS
A total of 204 patients had been intervened due to PA, of whom 57 were older than 70 years. Of these patients, 119 had a CPD, 11 extended lymphadenectomy, 66 with pyloric conservation, and 8 with extension to total pancreatectomy due to involvement of the section margin. Portal or mesenteric vein resection was included in 35 cases. Post-surgical complications were detected in 45% of cases, the most frequent being: slow gastric emptying (20%), surgical wound infection (17%), pancreatic fistula (10%), and serious medical complications (8%). Further surgery was required in 13%, and the over post-surgical mortality was 7%. A patient age greater than 70 years, post-surgical haemoperitoneum, gastroenteric dehiscence, and the presence of medical complications were post-surgical mortality risk factors in the multivariate analysis. Pancreatic fistula was not a factor associated with post-surgical mortality.


CONCLUSIONS
Cephalic duodenopancreatectomy is a safe technique but with a considerable morbidity. Patients over 70 years of age must be carefully selected before considering surgery. Serious medical complications must be treated aggressively to avoid an unfavourable progression.
Busquets
Juli
J
Servicio de Cirugía General y Digestiva, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España. jbusquets@bellvitgehospital.cat
Fabregat
Juan
J
Jorba
Rosa
R
Peláez
Núria
N
García-Borobia
Francisco
F
Masuet
Cristina
C
Valls
Carlos
C
Martínez-Carnicero
Laura
L
Lladó
Laura
L
Torras
Jaume
J
D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D004386:Duodenum / Q000601:surgery*; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies