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Erschienen in: Journal of Gastrointestinal Surgery 12/2007

01.12.2007 | original article

Long-term Anastomotic Complications After Pancreaticoduodenectomy for Benign Diseases

verfasst von: Kaye M. Reid-Lombardo, Antonio Ramos-De la Medina, Kristine Thomsen, William S. Harmsen, Michael B. Farnell

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 12/2007

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Abstract

Background

The study of long-term complications after pancreaticoduodenectomy (PD) for malignant disease has been problematic given the paucity of patients with long-term survival after diagnosis and surgical resection. We therefore studied patients who were surgically treated with a PD for a benign diagnosis to evaluate long-term anastomotic durability.

Methods

A retrospective analysis of 122 patients who had PD performed in the interval 1993–2003 inclusive for benign pancreatic diseases was undertaken. Long-term morbidity and mortality (specifically biliary, pancreaticojejunostomy [PJ], and gastrojejunostomy [GJ] strictures) were evaluated.

Results

Gender was equally represented with 53% female and 47% male. The median age at surgery was 55 years (range 15–81 years). The three most frequent diagnoses were chronic pancreatitis (40%), intraductal papillary mucinous neoplasm (16%), and cystic neoplasms (9%). Median follow-up in the 95 patients alive at last follow-up was 4.1 years (10 days–12.6 years). The 5- and 10-year survival rates were 83% (76, 91%) and 62% (49%, 78%), respectively. The observed survival was significantly lower than the expected survival in an age- and gender-matched U.S. white population, p < 0.001 (one-sample log-rank test). The 5- and 10-year cumulative probability of biliary stricture was 8% (2%, 14%) and 13% (4%, 22%), respectively. For pancreatic strictures the 5- and 10-year rates were 5% (0%, 9%) and 5% (0%, 9%), respectively. No GJ strictures were noted. The management of biliary strictures was primarily with dilatation and stent (78%) and less commonly operative intervention (22%). Pancreatic strictures required surgery alone (25%), surgery followed by endoscopic intervention (25%), or endoscopic therapy alone (50%).

Conclusion

Intervention for anastomotic strictures after pancreaticoduodenectomy is uncommon. Biliary strictures can usually be treated nonoperatively with dilation and stent. Our study likely underestimates the incidence of stricture formation. Prospective imaging studies may be warranted for a more accurate assessment of the rate of long-term anastomotic complications.
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Metadaten
Titel
Long-term Anastomotic Complications After Pancreaticoduodenectomy for Benign Diseases
verfasst von
Kaye M. Reid-Lombardo
Antonio Ramos-De la Medina
Kristine Thomsen
William S. Harmsen
Michael B. Farnell
Publikationsdatum
01.12.2007
Verlag
Springer-Verlag
Erschienen in
Journal of Gastrointestinal Surgery / Ausgabe 12/2007
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-007-0369-7

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