Management and outcomes of hemorrhage after distal pancreatectomy: a multicenter study at high volume centers

医学胃肠病学抗血栓远端胰腺切除术外科胰腺切除术内科学置信区间胰瘘回顾性队列研究胰腺

作者

C. Duclos,Thibault Durin,Ugo Marchese,Alain Sauvanet,Christophe Laurent,Ahmet Ayav,Olivıer Turrini,Laurent Sulpice,Pietro Addeo,Régis Souche,Julie Périnel,David Jérémie Birnbaum,Olivier Facy,Johan Gagnière,Sébastien Gaujoux,Lilian Schwarz,Nicolas Régenet,Antonio Iannelli,Jean-Marc Régimbeau,Guillaume Piessen,Stéphanie Truant,Mehdi El Amrani,Bruno Heyd,Alexandre Doussot,Célia Turco,S. Dokmak,Zineb Cherkaoui,David Fuks,Marie André,Ahmet Ayav,Cloé Magallon,Fabien Robin,Philippe Bachellier,Thomas Bardol,Mustapha Adham,Stylianos Tzedakis,Zaher Lakkis,Ecoline Tribillon,Edouard Roussel,Louise Barbier,Guillaume Piessen,Stéphanie Truant

出处

期刊：Hpb [Elsevier]
日期：2023-10-01

链接

hal.science hal.science nih.govdoi.org

标识

DOI：10.1016/j.hpb.2023.10.008

摘要

Abstract

Background

Data on clinically relevant post-pancreatectomy hemorrhage (CR-PPH) are derived from series mostly focused on pancreatoduodenectomy, and data after distal pancreatectomy (DP) are scarce.

Methods

All non-extended DP performed from 2014 to 2018 were included. CR-PPH encompassed grade B and C PPH. Risk factors, management, and outcomes of CR-PPH were evaluated.

Results

Overall, 1188 patients were included, of which 561 (47.2 %) were operated on minimally invasively. Spleen-preserving DP was performed in 574 patients (48.4 %). Ninety-day mortality, severe morbidity and CR-POPF rates were 1.1 % (n = 13), 17.4 % (n = 196) and 15.5 % (n = 115), respectively. After a median interval of 8 days (range, 0–37), 65 patients (5.5 %) developed CR-PPH, including 28 grade B and 37 grade C. Reintervention was required in 57 patients (87.7 %). CR-PPH was associated with a significant increase of 90-day mortality, morbidity and hospital stay (p < 0.001). Upon multivariable analysis, prolonged operative time and co-existing POPF were independently associated with CR-PPH (p < 0.005) while a chronic use of antithrombotic agent trended towards an increase of CR-PPH (p = 0.081). As compared to CR-POPF, the failure-to-rescue rate in patients who developed CR-PPH was significantly higher (13.8 % vs. 1.3 %, p < 0.001).

Conclusion

CR-PPH after DP remains rare but significantly associated with an increased risk of 90-day mortality and failure-to-rescue.