Prospective study of short term complications following pancreatoduodenectomy based on international definitions

BACKGROUND AND AIM: Though, the morbidity following pancreatoduodenectomy remains high the mortality rate has reduced to < 5% in many high volume centres. The aim of this prospective study was to quantify the complications following pylorus preserving pancreatoduodenectomy using international definitions and to prove that pylorus preservation and retrocolic duodenojejunostomy are not associated with increased incidence of delayed gastric emptying. METHODS: This was a prospective observational study at a single GI surgery referral unit, conducted from January 2010 to December 2012. Patients who underwent pylorus preserving pancreatoduodenectomy for various indications were included; barring those who underwent major surgical procedures along with pancreatoduodenectomy. RESULTS: 76 patients (M:F = 37:39) underwent pylorus preserving pancreatoduodenectomy during the study period; with median age 52 yrs (range: 29-83) and hospital stay 11 days (range: 8-50). Overall mortality and significant morbidity were 7.89% and 12.5%, respectively. Four patients each (5.26%) developed significant delayed gastric emptying (DGE) and pancreatic fistula. Presence of comorbidity (p = 0.019; odds ratio: 3.16) and periampullary tumours (p = 0.011; odds ratio: 7.91) were identified as risk factors for the development of complications. Pancreatic juice amylase levels in chronic pancreatitis were very low (p < 0.005). CONCLUSION: Pylorus preserving pancreatoduodenectomy can be performed with very low mortality and morbidity at high volume centres. DGE is not significantly increased with pylorus preservation and retrocolic duodenojejunostomy, and is often secondary to post-op complications. The International Study Group of Pancreatic Fistula (ISGPF) definition may miss pancreatic fistula in chronic pancreatitis.