Surgical outcomes after early unplanned reoperation after pancreaticoduodenectomy: a retrospective cohort study

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Abstract

Background
Pancreaticoduodenectomy (PD) is associated with high morbidity rate. About 15% of its complications need reoperation. The current study was conducted to evaluate the indications and outcomes of early reoperations after PD.
Patients and methods
A retrospective review of consecutive 948 cases that underwent PD for malignant lesions between 2000 and 2018 was done. Our primary outcome was hospital morbidity and mortality for early unplanned reoperation following PD, whereas secondary outcomes included prevalence, risk factors, indications, and long-term outcomes of reoperation.
Results
Early postoperative complications occurred in 328 (34.6%) patients. However, 76 (8%) patients underwent early reoperation. Post-pancreatectomy hemorrhage was the most common cause of exploration (48 cases) and anastomotic leakage (26 cases). On univariate analysis, BMI more than 25 kg/m, liver cirrhosis, mass size more than 2 cm, soft pancreas, and pancreatic duct less than 3 mm were risk factors for reoperation, and all these items remained significant on multivariate analysis except for BMI. In addition, bile leakage was a strong predictor of reoperation on the same multivariate analysis. Cases that underwent reoperations showed significant delay in oral intake, prolonged hospitalization, higher morbidity, and mortality rates. Although survival was comparable between both groups for 5-year-follow up, reoperation was associated with a significant increase in recurrence after 2 years.
Conclusion
Unplanned reoperation increases morbidity, mortality, and 2-year recurrence after PD. Liver cirrhosis, large mass size, soft pancreatic texture, small pancreatic duct, and bile leakage are strong predictors for dreadful complications.

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