Pancreaticoduodenectomy

Role of interventional radiologists in managing patients and complications

Taylor A. Sohn, Charles J. Yeo, John L. Cameron, Jeffrey F. Geschwind, Sally E. Mitchell, Anthony C. Venbrux, Keith D. Lillemoe

Research output: Contribution to journalArticle

130 Citations (Scopus)

Abstract

Although the mortality rate after pancreaticoduodenectomy has decreased, the morbidity rate remains high. Major morbidity is often managed with the aid of interventional radiologists. The objective of this study was to evaluate the cooperative roles of interventional radiologists and pancreatic surgeons in complex pancreatic surgery, specifically pancreaticoduodenectomy. Our pancreaticoduodenectomy database was reviewed for all patients undergoing pancreaticoduodenectomy between January 1, 1995 and December 31, 2000. The interventional radiologic procedures for each patient were evaluated. A total of 1061 patients underwent pancreaticoduodenectomy. The overall mortality and morbidity rates were 2.3% and 35%, respectively. Five hundred ninety patients (56%) had no interventional radiologic procedures, whereas 471 patients (44%) had interventional radiologic procedures. Of those, 342 (32%) had preoperative biliary drainage (PBD) and 129 (12%) required postoperative interventional radiologic procedures. Percutaneous aspiration/catheter drainage was required in 84 patients for intra-abdominal abscess, biloma, or lymphocele, with 24 requiring two or more abscess drains. Thirty-nine patients underwent postoperative PBD for bile leaks due to anastomotic disruption, undrained biliary segments, or T-tube/bile stent dislodgment. Eighteen patients had hemobilia/gastrointestinal bleeding treated by angiography with embolization. The reoperation rate for the entire cohort of 1061 patients was 4.1% (n = 43). Nineteen of the 129 patients (15%) requiring postoperative radiologic intervention required reoperation. Although 4 of 18 patients who required embolization for bleeding subsequently required surgical intervention for the same reason, only 4 of 84 patients undergoing abscess drainage later required operation for anastomotic disruption or unsuccessful percutaneous drainage. As would be expected, the patients who required postoperative radiologic intervention (n = 129) had a higher incidence of postoperative complications including pancreatic fistula (20% vs. 6%, P < 0.01), bile leakage (22% vs. 1%, P < 0.01), and wound infection (16% vs. 8%, P < 0.01). With the complications in these 129 patients, the postoperative mortality rate was only 6.2% compared to 1.7% in patients who did not require radiologic intervention (n = 932, P < 0.01). The median postoperative length of stay was 15 days in those patients requiring postoperative radiologic intervention, 10 days in those not requiring intervention (P < 0.01; postoperative interventional radiology vs. no postoperative interventional radiology), and 29.5 days for patients needing reoperation. Interventional radiologists play a critical role in the management of some patients undergoing pancreaticoduodenectomy. Although complications such as anastomotic leaks, abscess formation, and bleeding can result in increased mortality and a longer hospital stay, the skills of the interventional radiology team provide expert management of some life-threatening complications, thus avoiding reoperation, speeding recovery times, and minimizing morbidity.

Original languageEnglish (US)
Pages (from-to)209-219
Number of pages11
JournalJournal of Gastrointestinal Surgery
Volume7
Issue number2
DOIs
StatePublished - Feb 2003
Externally publishedYes

Fingerprint

Pancreaticoduodenectomy
Drainage
Reoperation
Interventional Radiology
Bile
Abscess
Morbidity
Radiologists
Mortality
Hemorrhage
Length of Stay
Lymphocele
Hemobilia
Abdominal Abscess
Pancreatic Fistula
Anastomotic Leak

Keywords

  • Complications
  • Interventional radiology
  • Pancreaticoduodenectomy

ASJC Scopus subject areas

  • Surgery

Cite this

Sohn, T. A., Yeo, C. J., Cameron, J. L., Geschwind, J. F., Mitchell, S. E., Venbrux, A. C., & Lillemoe, K. D. (2003). Pancreaticoduodenectomy: Role of interventional radiologists in managing patients and complications. Journal of Gastrointestinal Surgery, 7(2), 209-219. https://doi.org/10.1016/S1091-255X(02)00193-2

Pancreaticoduodenectomy : Role of interventional radiologists in managing patients and complications. / Sohn, Taylor A.; Yeo, Charles J.; Cameron, John L.; Geschwind, Jeffrey F.; Mitchell, Sally E.; Venbrux, Anthony C.; Lillemoe, Keith D.

In: Journal of Gastrointestinal Surgery, Vol. 7, No. 2, 02.2003, p. 209-219.

Research output: Contribution to journalArticle

Sohn, TA, Yeo, CJ, Cameron, JL, Geschwind, JF, Mitchell, SE, Venbrux, AC & Lillemoe, KD 2003, 'Pancreaticoduodenectomy: Role of interventional radiologists in managing patients and complications', Journal of Gastrointestinal Surgery, vol. 7, no. 2, pp. 209-219. https://doi.org/10.1016/S1091-255X(02)00193-2
Sohn, Taylor A. ; Yeo, Charles J. ; Cameron, John L. ; Geschwind, Jeffrey F. ; Mitchell, Sally E. ; Venbrux, Anthony C. ; Lillemoe, Keith D. / Pancreaticoduodenectomy : Role of interventional radiologists in managing patients and complications. In: Journal of Gastrointestinal Surgery. 2003 ; Vol. 7, No. 2. pp. 209-219.
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