Late Postpancreatectomy Hemorrhage After Pancreaticoduodenectomy: Is It Possible to Recognize Risk Factors?

Claudio Ricci; Riccardo Casadei; Salvatore Buscemi; Francesco Minni

doi:10.6092/1590-8577/622

Claudio Ricci Department of Surgical and Anesthesiological Sciences, Alma Mater Studiorum, University of Bologna, “S.Orsola-Malpighi” Hospital. Bologna, Italy
Riccardo Casadei Department of Surgical and Anesthesiological Sciences, Alma Mater Studiorum, University of Bologna, “S.Orsola-Malpighi” Hospital. Bologna, Italy
Salvatore Buscemi Department of Surgical and Anesthesiological Sciences, Alma Mater Studiorum, University of Bologna, “S.Orsola-Malpighi” Hospital. Bologna, Italy
Francesco Minni Department of Surgical and Anesthesiological Sciences, Alma Mater Studiorum, University of Bologna, “S.Orsola-Malpighi” Hospital. Bologna, Italy

DOI: https://doi.org/10.6092/1590-8577/622

Keywords: Pancreatectomy, Hemorrhage, Pancreatic Fistula

Abstract

Context Post-pancreatectomy hemorrhage is one of the most common complications after pancreaticoduodenectomy. Objective To evaluate the late post-pancreatectomy hemorrhage rate according to the International Study Group of Pancreatic Surgery criteria and to recognize factors related to its onset. Methods A prospective study of 113 patients who underwent pancreaticoduodenectomy was conducted. Late post-pancreatectomy hemorrhage was defined according to the criteria of the International Study Group of Pancreatic Surgery. Demographic, clinical, surgical and pathological data were considered and related to late post-pancreatectomy hemorrhage. Results Thirty-one (27.4%) patients had a post-pancreatectomy hemorrhage. Twenty-five (22.1%) patients developed late post-pancreatectomy hemorrhage: 19 (16.8%) grade B, 6 (5.3%) grade C. Surgical re-operation was performed in 2 out of the 25 cases with late post-pancreatectomy hemorrhage (8.0%) grade C associated with postoperative pancreatic fistula. At univariate analysis, the only factor significantly related to late post-pancreatectomy hemorrhage was postoperative pancreatic fistula (P<0.001). Multivariate analysis underlined that the severity of postoperative pancreatic fistula (P<0.001) and pancreatic anastomosis (P=0.049) independently increased the risk of late hemorrhage. Conclusion In patients undergoing pancreaticoduodenectomy, the criteria introduced by International Study Group of Pancreatic Surgery to define late postpancreatectomy hemorrhage are related to a higher incidence of hemorrhage than previously detected because they considered also mild hemorrhage.

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