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Zhang S, Yadav DK, Wang G, Jiang Y, Zhang J, Yadav RK, Singh A, Gao G, Chen J, Mao Y, Wang C, Meng Y, Hua Y. Causes and predictors of unplanned reoperations within 30 days post laparoscopic pancreaticoduodenectomy: a comprehensive analysis. Front Oncol 2024; 14:1464450. [PMID: 39257554 PMCID: PMC11385305 DOI: 10.3389/fonc.2024.1464450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 07/30/2024] [Indexed: 09/12/2024] Open
Abstract
Objective To delineate the risk factors and causes of unplanned reoperations within 30 days following laparoscopic pancreaticoduodenectomy (LPD). Methods A retrospective study reviewed 311 LPD patients at Ningbo Medical Center Li Huili Hospital from 2017 to 2024. Demographic and clinical parameters were analyzed using univariate and multivariate analyses, with P < 0.05 indicating statistical significance. Results Out of 311 patients, 23 (7.4%) required unplanned reoperations within 30 days post-LPD, primarily due to postoperative bleeding (82.6%). Other causes included anastomotic leakage, abdominal infection, and afferent loop obstruction. The reoperation intervals varied, with the majority occurring within 0 to 14 days post-surgery. Univariate analysis identified significant risk factors: diabetes, liver cirrhosis, elevated CRP on POD-3 and POD-7, pre-operative serum prealbumin < 0.15 g/L, prolonged operation time, intraoperative bleeding > 120 ml, vascular reconstruction, soft pancreatic texture, and a main pancreatic duct diameter ≤3 mm (all P < 0.05). Multivariate analysis confirmed independent risk factors: pre-operative serum prealbumin < 0.15 g/L (OR = 3.519, 95% CI 1.167-10.613), CRP on POD-7 (OR = 1.013, 95% CI 1.001-1.026), vascular reconstruction (OR = 9.897, 95% CI 2.405-40.733), soft pancreatic texture (OR = 5.243, 95% CI 1.628-16.885), and a main pancreatic duct diameter ≤3 mm (OR = 3.462, 95% CI 1.049-11.423), all associated with unplanned reoperation within 30 days post-LPD (all P < 0.05). Conclusion Postoperative bleeding is the primary cause of unplanned reoperations after LPD. Independent risk factors, confirmed by multivariate analysis, include low pre-operative serum prealbumin, elevated CRP on POD-7, vascular reconstruction, soft pancreatic texture, and a main pancreatic duct diameter of ≤3 mm. Comprehensive peri-operative management focusing on these risk factors can reduce the likelihood of unplanned reoperations and improve patient outcomes.
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Affiliation(s)
- Shiwei Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Dipesh Kumar Yadav
- Department of General Surgery, Wenzhou People's Hospital, The Third Clinical Institute Affiliated to Wenzhou Medical University, The Third Affiliated Hospital of Shanghai University, Wenzhou, China
| | - Gaoqing Wang
- Department of Hepatobiliary and Pancreatic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Yin Jiang
- Department of Hepatobiliary and Pancreatic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Jie Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Rajesh Kumar Yadav
- College of Pharmacy, University of Louisiana at Monroe, Monroe, LA, United States
| | - Alina Singh
- Department of Surgery, Parkland Medicare and Research Center, Janakpur, Nepal
| | - Guo Gao
- Department of Hepatobiliary and Pancreatic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Junyu Chen
- Department of Hepatobiliary and Pancreatic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Yefan Mao
- Department of Hepatobiliary and Pancreatic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Chengwei Wang
- Department of Hepatobiliary and Pancreatic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Yudi Meng
- Department of Hepatobiliary and Pancreatic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Yongfei Hua
- Department of Hepatobiliary and Pancreatic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China
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Zhang JL, Yuan B, Zhang H, Wang MQ. Transcatheter arterial embolization with N-butyl cyanoacrylate for postoperative hemorrhage treatment following pancreatoduodenectomy. Emerg Radiol 2024; 31:179-185. [PMID: 38334821 DOI: 10.1007/s10140-024-02211-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE Postoperative hemorrhage (PPH) is a severe complication of pancreatoduodenectomy (PD) with a mortality rate of 5-20.2% and mortality due to hemorrhage of 11-58%. Transcatheter arterial embolization (TAE) has been widely recommended for PPH, however, TAE with N-butyl cyanoacrylate (NBCA) for PPH treatment has been reported rarely. Therefore, this study aimed to evaluate the safety and efficacy of TAE with NBCA for PPH treatment following PD. METHODS This retrospective study included 14 male patients (mean age, 60.93 ± 10.97 years) with postoperative hemorrhage following PD treated with TAE using NBCA as the main embolic agent from October 2019 to February 2022. The clinical data, technical and success rate, and complications were analyzed. RESULTS Among the 14 patients who underwent TAE, the technical and clinical success rates were 100 and 85.71%, respectively. Angiography revealed contrast extravasation in 12 cases and a pseudoaneurysm in 3 cases. One patient developed a serious infection and died 2 days after the TAE. CONCLUSION TAE with NBCA for PPH treatment following PD, especially for massive hemorrhage caused by a pancreatic fistula, biliary fistula, or inflammatory corrosion, can result in rapid and effective hemostasis with high safety.
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Affiliation(s)
- Jin Long Zhang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, People's Republic of China
| | - Bing Yuan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Heng Zhang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
- Department of Radiology, National Clinical Research Center for Geriatric Diseases/Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Mao Qiang Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China.
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Kapranov MS, Kiselev AD, Brukh SL, Lugovskoi SS, Maslov KG, Kovalenko IB, Iarosh AL, Alkanany E. Possibilities of Endovascular Hemostasis in Treatment of Pancreatic Bleeding. ARCHIVES OF RAZI INSTITUTE 2022; 77:375-381. [PMID: 35891772 PMCID: PMC9288600 DOI: 10.22092/ari.2021.356560.1871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/09/2021] [Indexed: 06/15/2023]
Abstract
Pancreatic hemorrhage is one of the most severe complications of various pancreatic diseases that are difficult to treat even in multidisciplinary hospitals. Mortality from pancreatic hemorrhage can reach up to 80%. This study aimed to evaluate the possibility of maintaining endovascular homeostasis in the treatment of patients with pancreatic hemorrhage. This retrospective multicenter study included 45 patients (33 men and 12 women) in the age range of 27-84 years. More than 50% (n=23) of the patients were diagnosed with chronic pancreatitis. Malignant pancreatic lesions were observed in 22 patients; of whom11 patients had acute necrotizing pancreatitis. Acute bleeding was observed in 39 (86.6%) patients, and 6 (13.3%) patients showed chronic symptoms. Single-shot and recurrent bleeding was recorded in 22(48.9%) and 23 (51.1%) patients. In total, 57 patients underwent endovascular surgery. Moreover, 45 patients underwent primary surgery and another 12 (2.2%) underwent reoperation due to recurrent bleeding. Intraoperative complications occurred in 1 (2.2%) patient, and postoperative complications occurred in another. Out of all 45 patients, seven patients had 15 episodes of recurrent bleeding, of whom four patients showed recurrent bleeding at the in-hospital period, and the other three were under local supervision after the previous endovascular intervention. Out of the 45 patients, 35 (77.7%) survived and another 10 (22.2%) died due to multiple organ failure (n=8) and recurrent bleeding and hemorrhagic shock (n=2). Out of 10 patients who died, 4, 3, and 3patients showed malignant pancreatic lesions after surgery, acute pancreatitis, and chronic pancreatitis, respectively. Endovascular hemostatic interventions can significantly increase the survival rate in severe groups of patients with pancreatic bleeding. Endovascular hemostasis is a safe procedure and may be called the "method of choice" in the treatment of pancreatic bleeding, especially in combination with percutaneous draining, aspiration, and injection of liquid embolic agents into leakage of pancreatic juice.
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Affiliation(s)
- M S Kapranov
- Chair of Hospital Surgery, Belgorod State University, Belgorod, Russian Federation
| | - A D Kiselev
- Interventional Radiologist, Department of Interventional Radiology, Arkhangelsk Regional Clinical Hospital, Arkhangelsk, Russian Federation
| | - S L Brukh
- Interventional Radiologist, Department of Interventional Radiology, Moscow, Russian Federation
| | - S S Lugovskoi
- Interventional Radiologist, Department of Interventional Radiology, Belgorod Regional Clinical Hospital, Belgorod, Russian Federation
| | - K G Maslov
- Interventional Radiologist, Department of Interventional Radiology, Belgorod Regional Clinical Hospital, Belgorod, Russian Federation
| | - I B Kovalenko
- Chair of Hospital Surgery, Belgorod State University, Belgorod, Russian Federation
| | - A L Iarosh
- Chair of Hospital Surgery, Belgorod State University, Belgorod, Russian Federation
| | - E Alkanany
- Chair of Hospital Surgery, Belgorod State University, Belgorod, Russian Federation
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