Subtotal pancreatectomy in risky patients with periampullary cancers: new surgical center experience

Fadel, Bashir A.; Ibraheem, Tameem; Mahdy, Magdy M.; Mohamed, Khaled S.; Hassany, Sahar M.

doi:10.4103/ejs.ejs_44_20

Subtotal pancreatectomy in risky patients with periampullary cancers: new surgical center experience

Authors

Abstract

Background
The pancreatic leak is the most dangerous complication postpancreaticoduodenectomy. There are many risk factors for the development of pancreatic fistula (PF) such as texture of the pancreas and its duct size. The aim was to decrease the incidence of PF in these risky patients.
Patients and methods
A retrospective study was performed on 20 periampullary tumors patients treated by subtotal pancreatectomy between April 2015 and September 2017, which were performed in Assiut Al Rajhi Liver Hospital. Subtotal pancreatectomy was performed in patients with soft pancreas which could not hold stitches and small duct size of less than 3 mm. Also, the authors follow the results of postoperative pancreatic leakage, other morbidity and mortality.
Results
A PF type A developed in three cases and did not require any further management, one case developed PF type B who also developed delayed gastric emptying and improved after 3 months; one case of abdominal abscess was managed by insertion of pig tail; two cases of wound infection improved by repeated dressing; the mean hospital stay was 7 days except for the patient who developed PF type B and delayed gastric emptying whose hospital stay was prolonged to 1 month; the mortality rate was one case, who was a female patient of 70 years old and died by myocardial infarction 1 week postoperatively.
Conclusion
Subtotal pancreatectomy with stapling can be done safely in risky patients to decrease the incidence of PF, but further large randomized trials are needed.

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