Postoperative Morbidity and Mortality of Pancreaticoduodenectomy for Periampullary Cancer

Fong Fu Chou, Shyr Ming Sheen-Chen, Yaw Sen Chen, Mao Chan Chen, Chao Long Chen

Research output: Contribution to journalArticle

82 Citations (Scopus)

Abstract

Objective: To find out factors that may influence the mortality after Whipple's operation, whether duct to mucosa anastomosis is better than classic "dunking" pancreaticojejunostomy and whether age over 70 is a contraindication for this procedure. Design: Prospectively randomised study. Setting: Teaching hospital, Taiwan, R.O.C. Patients: 93 patients with periampullary cancer undergoing Whipple's operation were randomly divided into two groups. Forty-six with periampullary cancer underwent invaginating pancreaticojejunostomy, and 47 patients underwent duct to mucosa anastomosis for reconstruction. Main Outcome Measures: Mortality and morbidity were compared between two groups. Results: The over all mortality was 8% (7/93). An albumin concentration of less than 30 g/L before operation and operative blood loss influenced the surgical mortality both in the univariate and multivariate analysis. Age over 70 years was not a factor. Patients with duct to mucosa anastomoses had a leak rate of 4% (2/47), morbidity of 21% (10/47) and mortality of 6% (3/47). Patients with an invaginated pancreaticojejunostomy had a leak rate of 15% (7/46), morbidity of 33% (15/46), and mortality of 9% (4/46). The need for total parenteral nutrition in the invaginated group (33%) was statistically greater than in the other group (11%) (p = 0.01). Conclusions: The morbidity and mortality of pancreaticoduodenectomy for periampullary cancer although slightly greater for patients over the age of 70 are acceptable. The factors that may influence the mortality are an albumin concentration of less then 30 g/L and the amount of blood lost during operation. The duct to mucosa anastomosis is a safe procedure, which has a lower leak rate and less need for total parenteral nurition than pancreaticojejunostomy.

Original languageEnglish
Pages (from-to)477-481
Number of pages5
JournalEuropean Journal of Surgery
Volume162
Issue number6
Publication statusPublished - Dec 1 1996
Externally publishedYes

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Pancreaticoduodenectomy
Pancreaticojejunostomy
Morbidity
Mortality
Neoplasms
Mucous Membrane
Albumins
Surgical Blood Loss
Total Parenteral Nutrition
Taiwan
Teaching Hospitals
Multivariate Analysis
Outcome Assessment (Health Care)

Keywords

  • Duct to mucosa anastomosis
  • Invaginated pancreaticojejunostomy
  • Whipple's operation

ASJC Scopus subject areas

  • Surgery

Cite this

Postoperative Morbidity and Mortality of Pancreaticoduodenectomy for Periampullary Cancer. / Chou, Fong Fu; Sheen-Chen, Shyr Ming; Chen, Yaw Sen; Chen, Mao Chan; Chen, Chao Long.

In: European Journal of Surgery, Vol. 162, No. 6, 01.12.1996, p. 477-481.

Research output: Contribution to journalArticle

Chou, Fong Fu ; Sheen-Chen, Shyr Ming ; Chen, Yaw Sen ; Chen, Mao Chan ; Chen, Chao Long. / Postoperative Morbidity and Mortality of Pancreaticoduodenectomy for Periampullary Cancer. In: European Journal of Surgery. 1996 ; Vol. 162, No. 6. pp. 477-481.
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AU - Chen, Chao Long

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N2 - Objective: To find out factors that may influence the mortality after Whipple's operation, whether duct to mucosa anastomosis is better than classic "dunking" pancreaticojejunostomy and whether age over 70 is a contraindication for this procedure. Design: Prospectively randomised study. Setting: Teaching hospital, Taiwan, R.O.C. Patients: 93 patients with periampullary cancer undergoing Whipple's operation were randomly divided into two groups. Forty-six with periampullary cancer underwent invaginating pancreaticojejunostomy, and 47 patients underwent duct to mucosa anastomosis for reconstruction. Main Outcome Measures: Mortality and morbidity were compared between two groups. Results: The over all mortality was 8% (7/93). An albumin concentration of less than 30 g/L before operation and operative blood loss influenced the surgical mortality both in the univariate and multivariate analysis. Age over 70 years was not a factor. Patients with duct to mucosa anastomoses had a leak rate of 4% (2/47), morbidity of 21% (10/47) and mortality of 6% (3/47). Patients with an invaginated pancreaticojejunostomy had a leak rate of 15% (7/46), morbidity of 33% (15/46), and mortality of 9% (4/46). The need for total parenteral nutrition in the invaginated group (33%) was statistically greater than in the other group (11%) (p = 0.01). Conclusions: The morbidity and mortality of pancreaticoduodenectomy for periampullary cancer although slightly greater for patients over the age of 70 are acceptable. The factors that may influence the mortality are an albumin concentration of less then 30 g/L and the amount of blood lost during operation. The duct to mucosa anastomosis is a safe procedure, which has a lower leak rate and less need for total parenteral nurition than pancreaticojejunostomy.

AB - Objective: To find out factors that may influence the mortality after Whipple's operation, whether duct to mucosa anastomosis is better than classic "dunking" pancreaticojejunostomy and whether age over 70 is a contraindication for this procedure. Design: Prospectively randomised study. Setting: Teaching hospital, Taiwan, R.O.C. Patients: 93 patients with periampullary cancer undergoing Whipple's operation were randomly divided into two groups. Forty-six with periampullary cancer underwent invaginating pancreaticojejunostomy, and 47 patients underwent duct to mucosa anastomosis for reconstruction. Main Outcome Measures: Mortality and morbidity were compared between two groups. Results: The over all mortality was 8% (7/93). An albumin concentration of less than 30 g/L before operation and operative blood loss influenced the surgical mortality both in the univariate and multivariate analysis. Age over 70 years was not a factor. Patients with duct to mucosa anastomoses had a leak rate of 4% (2/47), morbidity of 21% (10/47) and mortality of 6% (3/47). Patients with an invaginated pancreaticojejunostomy had a leak rate of 15% (7/46), morbidity of 33% (15/46), and mortality of 9% (4/46). The need for total parenteral nutrition in the invaginated group (33%) was statistically greater than in the other group (11%) (p = 0.01). Conclusions: The morbidity and mortality of pancreaticoduodenectomy for periampullary cancer although slightly greater for patients over the age of 70 are acceptable. The factors that may influence the mortality are an albumin concentration of less then 30 g/L and the amount of blood lost during operation. The duct to mucosa anastomosis is a safe procedure, which has a lower leak rate and less need for total parenteral nurition than pancreaticojejunostomy.

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KW - Invaginated pancreaticojejunostomy

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