Post-pancreaticoduodenectomy hemorrhage risk factors, managements and outcomes

Feng, Jian; Chen, Yongliang; Dong, Jiahong; Chen, Mingyi; Cai, Shouwang; Huang, Zhiqiang

doi:10.1016/s1499-3872(14)60276-9

Cited by 55 publications

(84 citation statements)

References 27 publications

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“…Pancreaticoduodenectomy (PD) is a complex procedure involving extensive resection with significant risk of postoperative complication such as pancreatic and biliary fistula, delayed gastric emptying, abscess formation, and postpancreatectomy hemorrhage (PPH) [1]. Despite improvements in surgical approaches, the rate of complications remains high at 30–50% and the mortality is still significant, even in high volume centers [1–4].…”

Section: Introductionmentioning

confidence: 99%

“…Despite improvements in surgical approaches, the rate of complications remains high at 30–50% and the mortality is still significant, even in high volume centers [1–4]. …”

Section: Introductionmentioning

confidence: 99%

“…Due to vast improvements in care in the last decades, the incidence of PPH is relatively low at 3–10% but nevertheless has a high mortality rate at 20–50% [1, 5–17]. Therefore, when PPH occurs, it has to be considered a life-threatening condition.…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, late PPH is usually a complication of pancreatic fistula or abdominal abscess [10, 13, 23] and is assessed and treated using angiography and endoscopy. Nevertheless, the prognosis of PPH remains poor despite advances in imaging and treatment, and no preventive measure is recognized [1]. …”

Section: Introductionmentioning

confidence: 99%

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Risk Factors and Treatment for Hemorrhage after Pancreaticoduodenectomy: A Case Series of 423 Patients

Gao

Quan

et al. 2016

BioMed Research International

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The study aimed to investigate the risk factors of postpancreatectomy hemorrhage (PPH) after pancreaticoduodenectomy (PD). A retrospective analysis of 423 patients who underwent PD between January 2008 and January 2014 was conducted. The overall incidence and all-cause mortality of PPH were 9.9% (42/423) and 2.1% (9/423), respectively. Independent risk factors of early PPH were revascularization (odds ratio (OR) = 6.786; 95% confidence interval (95% CI): 1.785–25.792; P = 0.005), history of abdominal surgery (OR = 5.009; 95% CI: 1.968–12.749; P = 0.001), and preoperative albumin levels (OR = 4.863; 95% CI: 1.962–12.005; P = 0.001). Independent risk factors of late PPH included postoperative pancreatic leakage (OR = 4.696; 95% CI: 1.605–13.740; P = 0.005), postoperative biliary fistula (OR = 6.096; 95% CI: 1.575–23.598; P = 0.009), postoperative abdominal infection (OR = 4.605; 95% CI: 1.108–19.144; P = 0.036), revascularization (OR = 9.943; 95% CI: 1.900–52.042; P = 0.007), history of abdominal surgery (OR = 8.790; 95% CI: 2.779–27.806; P < 0.001), and preoperative albumin levels (OR = 5.563; 95% CI: 1.845–16.776; P = 0.002).

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Section: Introductionmentioning

confidence: 99%

“…Despite improvements in surgical approaches, the rate of complications remains high at 30–50% and the mortality is still significant, even in high volume centers [1–4]. …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Risk Factors and Treatment for Hemorrhage after Pancreaticoduodenectomy: A Case Series of 423 Patients

Gao

Quan

et al. 2016

BioMed Research International

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“…However, post-PD bleeding, or pseudoaneurysm formation, remains the most life-threatening complication (1,2). Several studies have described endovascular treatment with covered stent placement for the bleeding event (3)(4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Delayed Pseudoaneurysm Rupture and Management After Covered Stent Placement for Post Pancreaticoduodenectomy Hemorrhage: A Case Report

et al. 2017

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The development of a pseudoaneurysm following Fluency ® Plus-covered stent placement for post-Whipple operation bleeding has not been reported. A 79 year-old man diagnosed with pancreas head cancer received Whipple operation and suffered from subsequent gastroduodenal artery stump bleeding. The hemorrhage was treated successfully by covered stent placement at the common hepatic artery. However, two episodes of pseudoaneurysm formation at the proximal stent edge occurred successively in the followup period and were treated with endovascular managements. Sequential development of pseudoaneurysm after covered stent placement for post-Whipple operation bleeding has not been reported in available literature. We consider the pseudoaneurysm formation is not only a consequence of visceral inflammation, but also related to the properties of a stent like rigidity in this case.

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Hemorrhage Sites and Mitigation Strategies After Pancreaticoduodenectomy

Preston,

Collins,

Gönen

et al. 2024

JAMA Surg

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ImportancePostpancreatectomy hemorrhage is an uncommon but highly morbid complication of pancreaticoduodenectomy. Clinical evidence often draws suspicion to the gastroduodenal artery stump, even without a clear source.ObjectiveTo determine the frequency of gastroduodenal artery bleeding compared to other sites and the results of mitigation strategies.Design, Setting, and ParticipantsThis cohort study involved a retrospective analysis of data for consecutive patients who had pancreaticoduodenectomy from 2011 to 2021 at Memorial Sloan Kettering Cancer Center (MSK) and Thomas Jefferson University Hospital (TJUH).ExposuresDemographic, perioperative, and disease-related variables.Main Outcomes and MeasuresThe incidence, location, treatment, and outcomes of primary (initial) and secondary (recurrent) hemorrhage requiring invasive intervention were analyzed. Imaging studies were re-reviewed by interventional radiologists to confirm sites.ResultsInclusion criteria were met by 3040 patients (n = 1761 MSK, n = 1279 TJUH). Patients from both institutions were similar in age (median [IQR] age at MSK, 67 [59-74] years, and at TJUH, 68 [60-75] years) and sex (at MSK, 814 female [46.5%] and 947 male [53.8%], and at TJUH, 623 [48.7%] and 623 male [51.3%]). Primary hemorrhage occurred in 90 patients (3.0%), of which the gastroduodenal artery was the source in 15 (16.7%), unidentified sites in 24 (26.7%), and non–gastroduodenal artery sites in 51 (56.7%). Secondary hemorrhage occurred in 23 patients; in 4 (17.4%), the gastroduodenal artery was the source. Of all hemorrhage events (n = 117), the gastroduodenal artery was the source in 19 (16.2%, 0.63% incidence in all pancreaticoduodenectomies). Gastroduodenal artery hemorrhage was more often associated with soft gland texture (14 [93.3%] vs 41 [62.1%]; P = .02) and later presentation (median [IQR], 21 [15-26] vs 10 days [5-18]; P = .002). Twenty-three patients underwent empirical gastroduodenal artery embolization or stent placement, 7 (30.4%) of whom subsequently experienced secondary hemorrhage. Twenty percent of all gastroduodenal artery embolizations/stents (8/40 patients), including 13% (3/13 patients) of empirical treatments, were associated with significant morbidity (7 hepatic infarction, 4 biliary stricture), with a 90-day mortality rate of 38.5% (n = 5) for patients with these complications vs 7.8% without (n = 6; P = .008). Ninety-day mortality was 12.2% (n = 11) for patients with hemorrhage (3 patients [20%] with primary gastroduodenal vs 8 [10.7%] for all others; P = .38) compared with 2% (n = 59) for patients without hemorrhage.Conclusions and RelevanceIn this study, postpancreatectomy hemorrhage was uncommon and the spectrum was broad, with the gastroduodenal artery responsible for a minority of bleeding events. Empirical gastroduodenal artery embolization/stent without obvious sequelae of recent hemorrhage was associated with significant morbidity and rebleeding and should not be routine practice. Successful treatment of postpancreatectomy hemorrhage requires careful assessment of all potential sources, even after gastroduodenal artery mitigation.

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Post-pancreaticoduodenectomy hemorrhage risk factors, managements and outcomes

Cited by 55 publications

References 27 publications

Risk Factors and Treatment for Hemorrhage after Pancreaticoduodenectomy: A Case Series of 423 Patients

Risk Factors and Treatment for Hemorrhage after Pancreaticoduodenectomy: A Case Series of 423 Patients

Delayed Pseudoaneurysm Rupture and Management After Covered Stent Placement for Post Pancreaticoduodenectomy Hemorrhage: A Case Report

Hemorrhage Sites and Mitigation Strategies After Pancreaticoduodenectomy

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