Management of recurrent bleeding after pancreatoduodenectomy

Staerkle, Ralph F.; Gundara, Justin S.; Hugh, Thomas J.; Maher, Richard; Steinfort, Brendan; Samra, Jaswinder S.

doi:10.1111/ans.13976

Cited by 4 publications

(1 citation statement)

References 37 publications

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“…Delayed internal hemorrhage after pancreaticoduodenectomy is a rare complication with a very high mortality rate [ 15 , 16 ]. Bleeding is a result of vascular erosion related to bile and pancreatic juice, which is rich in proteolytic enzymes from pancreatic duct leakage and/or local infection [ 16 , 17 , 18 ]. Although postoperative internal hemorrhage is most often observed within 4 weeks after an operation, there were five patients in this study where bleeding occurred more than 4 weeks after the operation.…”

Section: Discussionmentioning

confidence: 99%

Comparing the Clinical Efficacy of Coil Embolization in GDA Stump versus Common Hepatic Artery in Postoperative Hemorrhage after Pancreatoduodenectomy

Chen

Lee

et al. 2023

JPM

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Background: Hemorrhage after pancreaticoduodenectomy is an uncommon but fatal complication. In this retrospective study, the different treatment modalities and outcomes for treating post-pancreaticoduodenectomy hemorrhage are analyzed. Methods: Our hospital imaging database was queried to identify patients who had undergone pancreaticoduodenectomy during the period of 2004–2022. The patients were retrospectively split into three groups, according to their treatment: conservative treatment without embolization (group A: A1, negative angiography; A2, positive angiography), hepatic artery sacrifice/embolization (group B: B1, complete; B2, incomplete), and gastroduodenal artery (GDA) stump embolization (group C). Results: There were 28 patients who received angiography or transarterial embolization (TAE) treatment 41 times (cases). In group A, high re-bleeding rates (54.5%, 6/11 cases) were observed, with 44.4% (4/9 cases) for subgroup A1 and 100% (2/2 cases) for subgroup A2. In group B, the re-bleeding rates were lowest (20%, 4/20 cases) with 0% (0/16 cases) for subgroup B1 and 100% (4/4 cases) for subgroup B2. The rate of post-TAE complications (such as hepatic failure, infarct, and/or abscess) in group B was not low (35.3%, 6/17 patients), especially in patients with underlying liver disease, such as liver cirrhosis and post-hepatectomy (100% (3/3 patients), vs. 21.4% (3/14 patients); p = 0.0294, p < 0.05). The highest rate of re-bleeding (55.6%, 5/9 cases) was observed for group C. There was a significant difference in the re-bleeding rates of subgroup B1 and group C (p = 0.002). The more iterations of angiography, the higher the mortality rate (16.7% (2/12 patients), <3 times vs. 60% (3/5 patients), ≥3 times; p = 0.1165). Conclusions: The complete sacrifice of the hepatic artery is an effective first-line treatment for pseudoaneurysm or for the rupture of the GDA stump after pancreaticoduodenectomy. Hepatic complications are not uncommon and are highly associated with underlying liver disease. Conservative treatment, the selective embolization of the GDA stump, and incomplete hepatic artery embolization do not provide enduring treatment effects.

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Section: Discussionmentioning

confidence: 99%

Comparing the Clinical Efficacy of Coil Embolization in GDA Stump versus Common Hepatic Artery in Postoperative Hemorrhage after Pancreatoduodenectomy

Chen

Lee

et al. 2023

JPM

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Timely synergic surgical and radiological aggressiveness improves perioperative mortality after hemorrhagic complication in Whipple procedure

Chierici

Intotero

Granieri

et al. 2021

Hepatobiliary & Pancreatic Diseases International

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Pancreatoduodenectomy With Arterial Resection for Locally Advanced Pancreatic Cancer of the Head

et al. 2020

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The development of increasingly effective chemotherapy regimens and increasing tumor necrosis is allowing radical pancreatectomy to be re-evaluated. This systematic review examines the outcome of patients with locally advanced cancer of the pancreatic head after pancreatectomy with arterial resection. Electronic searches were performed on PubMed and Medline databases between January 2000 and December 2018. The end points were to determine the safety and overall survival after arterial resection in pancreatectomy. Thirteen studies with 467 patients were included. Celiac, hepatic, mesenteric, and splenic arteries were resected across all studies. The median overall morbidity was 52% (range, 37%–100%) and with major complications occurring in a median of 25% (range, 12%–54%) of patients. The median 90-day mortality was 5% (range, 0%–17%). R0 was achieved in 66% (range, 43%–100%) and R1 in 31% (range, 0%–74%). The median survival was 17 (range, 7–29) months with a 1- and 3-year survival of 59% (range, 16%–92%) and 17% (range, 0%–13%), respectively. Pancreatectomy with arterial resection may be safely performed in high-volume centers with acceptable survival results in highly selected patients. Pooling of data through a multi-institutional registry will allow a more accurate assessment of the safety and efficacy of this treatment strategy.

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Management of recurrent bleeding after pancreatoduodenectomy

Cited by 4 publications

References 37 publications

Comparing the Clinical Efficacy of Coil Embolization in GDA Stump versus Common Hepatic Artery in Postoperative Hemorrhage after Pancreatoduodenectomy

Comparing the Clinical Efficacy of Coil Embolization in GDA Stump versus Common Hepatic Artery in Postoperative Hemorrhage after Pancreatoduodenectomy

Timely synergic surgical and radiological aggressiveness improves perioperative mortality after hemorrhagic complication in Whipple procedure

Pancreatoduodenectomy With Arterial Resection for Locally Advanced Pancreatic Cancer of the Head

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