Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2015; 21(22): 6937-6943
Published online Jun 14, 2015. doi: 10.3748/wjg.v21.i22.6937
Clinical impact of preoperative acute pancreatitis in patients who undergo pancreaticoduodenectomy for periampullary tumors
Yong-Hua Chen, Si-Ming Xie, Hao Zhang, Chun-Lu Tan, Neng-Wen Ke, Gang Mai, Xu-Bao Liu
Yong-Hua Chen, Si-Ming Xie, Hao Zhang, Chun-Lu Tan, Neng-Wen Ke, Gang Mai, Xu-Bao Liu, Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Liu XB and Mai G contributed equally to this work and are considered as joint corresponding authors; Liu XB, Chen YH and Mai G designed the research; Chen YH, Liu XB, Mai G, Xie SM, Zhang H, Tan CL and Ke NW performed the research; Chen YH, Xie SM and Zhang H analyzed the data; Chen YH and Xie SM wrote the paper; all authors read and approved the final manuscript.
Supported by Special Research Fund for Public Welfare Industry of Health, No. 201202007.
Ethics approval: The study was conducted in accordance with the principles of the Declaration of Helsinki and the guidelines of West China Hospital.
Informed consent: All patients or their legal representatives provided written informed consent.
Conflict-of-interest: There is no conflict of interest of any of the authors.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xu-Bao Liu, MD, Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China. xbliu@medmail.com.cn
Telephone: +86-28-85422477 Fax: +86-28-85164035
Received: October 28, 2014
Peer-review started: October 29, 2014
First decision: November 14, 2014
Revised: December 11, 2014
Accepted: February 5, 2015
Article in press: February 5, 2015
Published online: June 14, 2015
Processing time: 233 Days and 2.5 Hours
Abstract

AIM: To investigate the impact of preoperative acute pancreatitis (PAP) on the surgical management of periampullary tumors.

METHODS: Fifty-eight patients with periampullary tumors and PAP were retrospectively analyzed. Thirty-four patients who underwent pancreaticoduodenectomy (PD) and 4 patients who underwent total pancreatectomy were compared with a control group of 145 patients without PAP during the same period.

RESULTS: The preoperative waiting time was significantly shorter for the concomitant PAP patients who underwent a resection (22.4 d vs 54.6 d, P < 0.001) compared to those who did not. The presence of PAP significantly increased the rate of severe complications (Clavien grade 3 or higher) (17.6% vs 4.8%, P = 0.019) and lengthened the hospital stay (19.5 d vs 14.5 d, P = 0.006). A multivariate logistic regression analysis revealed that PAP was an independent risk factor for postoperative pancreatic fistula (OR = 2.91; 95%CI: 1.10-7.68; P = 0.032) and severe complications (OR = 4.70; 95%CI: 1.48-14.96; P = 0.009) after PD. There was no perioperative mortality.

CONCLUSION: PAP significantly increases the incidence of severe complications and lengthens the hospital stay following PD. PD could be safely performed in highly selective patients with PAP.

Keywords: Pancreaticoduodenectomy; Complications; Preoperative pancreatitis; Pancreatic fistula

Core tip: To date, it remains unclear how preoperative acute pancreatitis (PAP) affects the surgical management of periampullary tumors. We analyzed patients with periampullary tumors and concomitant PAP who were treated in a high-volume center. In the present study, we showed that PAP delays the resection of periampullary tumors and significantly increases the incidence of severe complications and lengthens the hospital stay following pancreaticoduodenectomy (PD). The study results suggest that PD could be safely performed in highly selective patients with PAP.