الفهرس | Only 14 pages are availabe for public view |
Abstract Pancreaticoduodenectomy (PD) remains the standard surgical treatment for various pathologies of the pancreas and the periampullary area. Nonetheless, PD remains a complicated surgical procedure that can significantly impact a patient’s subsequent quality of life. Aim of the study: The aim of this study is to identify the preoperative and intra-operative variables; to identify the factors that might contribute to serious complications and mortality of patients after pancreaticoduodenectomy. Method: This is retrospective and prospective hospital based study that been done on all patients who underwent pancreaticoduodenectomy in National Liver Institute between the first of January 2008 till the end of June 2013. Files of the all patients in the surgery department in National Liver Institute will be revised to collect pre-operative and intra- operative data as regard: Age, Sex, Current smoking within last year, Alcohol intake, other comorbidities (DM, CAD, and hypertension), Preoperative biliary drainage (ERCP or PTD). Preoperative CBC, Albumin, Bilirubin (Total & Direct), SGOT, SGPT, Alkaline phosphatase, GGT, Creatinine, Urea, Blood sugar, Coagulation profile (PT, PTT & INR), Tumor markers (CEA, CA 19.9), and serum amylase and lipase, were assessed. Preoperative radiological values including abdominal ultrasound, abdominal tri-phasic CT (type and size of the tumor, vascular invasion, LN metastases, Liver or distant metastases), MRCP, ERCP, Ultrasound (EUS), Biopsy either radiological guided or EUS, Chest X- ray & CT, were reported. Operative variables including type of pancreaticoduodenectomy (Standard or Pylorus-sparing), Blood transfusions, Operative time, Lymph node status, Superior mesenteric vein or portal vein involvement, Consistency of pancreas, type of anastomosis (pancreaticojejunostomy or pancreaticogastrostomy), pancreatic duct stenting, PV resection and anastomosis were assessed. Post-operative data including Histopathological examination of the resected mass (Size of the tumor, type of the tumor, resection margins) were involved in the study. During the first six months after pancreaticoduodenectomy serious complications and mortality will be considered as early outcome related to the operation which includes: pancreatic leak, bile leak, delayed gastric emptying, bleeding requiring, blood transfusion, re- exploration (cause, findings and the procedure), and recurrence. Mortality: Hospital mortality: within 30 days after operation, Late mortality within the 1sth 6th months. Results: Between the first of January 2008 and the end of June 2013, 102 patients underwent pancreaticoduodenectomy at the National Liver Institute, Menoufiya University. As regard univariate analysis, the patient’s age is the only preoperative variable found to be statistically significant with the incidence of delayed gastric emptying (P value < 0.05). As regard the univariate analysis of the intraoperative variables, the consistency of the pancreas, pancreatic duct size, operative time and blood loss were statistically significant with the incidence of pancreatic leak. The Blood loss was significant with the incidence of bile leak. The type of pancreaticoenteric anastomosis, pancreatic duct size and tumor size were significant with the incidence of delayed gastric emptying. The operative time, blood loss and blood transfusion were significant with the incidence of wound infection. As regard univariate analysis, the only pathological variable found to be statistically significant with the incidence of postoperative major complications is the type of the origin of the tumor with the incidence of postoperative bile leak. As regard multivariate analysis, the origin of the tumor and blood loss was significant with the incidence of postoperative bile leak. The blood loss was significant with the postoperative wound infection. |