Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2023; 15(5): 834-846
Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.834
Surgical management of high-grade pancreatic injuries: Insights from a high-volume pancreaticobiliary specialty unit
Juanita Noeline Chui, Krishna Kotecha, Tamara MH Gall, Anubhav Mittal, Jaswinder S Samra
Juanita Noeline Chui, Krishna Kotecha, Tamara MH Gall, Anubhav Mittal, Jaswinder S Samra, Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney 2065, NSW, Australia
Juanita Noeline Chui, Anubhav Mittal, Jaswinder S Samra, Faculty of Medicine and Health, University of Sydney, Sydney 2006, NSW, Australia
Anubhav Mittal, Department of Surgery, University of Notre Dame, Sydney 2006, NSW, Australia
Author contributions: Chui JN contributed to data collection and synthesis, drafting of original manuscript and revisions; Kotecha K contributed to review of manuscript and revisions; Gall TM contributed to review of manuscript and revisions; Mittal A contributed to review of manuscript and revisions; conceptualisation; Samra JS contributed to review of manuscript and revisions; conceptualisation
Institutional review board statement: Research protocol was approved by the Northern Sydney Local Health District ethics committee as a negligible/Low risk project. This study was not a trial or animal study.
Informed consent statement: Data was de-identified and retrospectively collected, and therefore informed consent was not required from each patient.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The authors confirm that the data supporting the findings of this study are available within the article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
Corresponding author: Juanita Noeline Chui, BSc (Adv), MD, Doctor, Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Reserve Road, St Leonards, Sydney 2065, NSW, Australia.
Received: December 3, 2022
Peer-review started: December 3, 2022
First decision: January 12, 2023
Revised: January 22, 2023
Accepted: March 14, 2023
Article in press: March 14, 2023
Published online: May 27, 2023
Research background

The management of high-grade pancreatic trauma is controversial.

Research motivation

The literature consists predominantly of studies conducted in regions such as North America and South Africa, where penetrating abdominal trauma occur with high prevalence. However, blunt abdominal trauma is more common than penetrating trauma in Australasian centres, and are underrepresented in the literature. While pancreatic injuries are estimated to occur in 20%-30% of penetrating abdominal trauma, they are observed in less than 2% of blunt trauma cases worldwide[13]. Furthermore, trauma services are not centralised in Australian healthcare settings. These regional differences are likely to have important implications for patient management and outcomes.

Research objectives

This study reviews the experience of an Australian tertiary referral center, with the aim of providing locally relevant insights into the management of high-grade pancreatic injuries.

Research methods

A retrospective review of records was performed on all patients undergoing surgical intervention for high-grade pancreatic injuries [American Association for the Surgery of Trauma (AAST) Grade III or greater] at a single Australian centre between January 2001 and December 2022.

Research results

Over a twenty-year period, 14 patients underwent pancreatic resection for high-grade injuries. Seven patients sustained AAST Grade III injuries and 7 were classified as Grades IV or V. Nine underwent distal pancreatectomy and 5 underwent pancreaticoduodenectomy (PD). Overall, there was a predominance of blunt aetiologies (11/14). Concomitant intra-abdominal injuries were observed in 11 patients and traumatic haemorrhage in 6 patients. Three patients developed clinically relevant pancreatic fistulas and there was one in-hospital mortality secondary to multi-organ failure. Among stable presentations, pancreatic ductal injuries were missed in two-thirds of cases (7/12) on initial computed tomography imaging and subsequently diagnosed on repeat imaging or endoscopic retrograde cholangiopancreatography. All patients who sustained complex pancreaticoduodenal trauma underwent PD without mortality.

Research conclusions

Penetrating and blunt trauma presentations are associated with varied patterns of injury. The management of pancreatic trauma is evolving; there is a growing role for endovascular and endoscopic techniques in the contemporary management of pancreatic trauma. Pancreatic resections including PD may be indicated and safely performed with appropriate specialist surgical, gastroenterology, and interventional radiology support in tertiary centres.

Research perspectives

We advocate that high-grade pancreatic trauma should be managed in high-volume hepato-pancreato-biliary specialty surgical units.