PANCREATICOJEJUNAL ANASTOMOTIC LEAK AFTER PANCREATICODUODENECTOMY - MULTIVARIATE-ANALYSIS OF PERIOPERATIVE RISK-FACTORS

The records of 131 consecutive patients with periampullary carcinoma w ho underwent pancreaticoduodenectomy within a 12-year period were revi ewed to determine the perioperative risk factors of pancreaticojejunal (PJ) anastomotic leak. Twenty-one PJ leaks were identified, for a fre quency of 16% (21 of 131); 19% (4 of 21) of these patients eventually died of PJ leak-realated complications. A total of 23 items of periope rative data, presumed as risk factors predisposing to PJ leak, were ex amined. By univariate analysis, advanced age, prolonged duration of un treated jaundice, deep jaundice, decreased creatinine clearance, incre ased intraoperative blood loss, and shock during operation were statis tically significant. However, by multivariate analysis, only duration of jaundice, creatinine clearance, and intraoperative blood loss turne d out to be independent risk factors. Noteworthily, jaundiced patients with impaired creatinine clearance not only had a higher incidence of PJ leak, but were also more liable to experience sepsis and intraabdo minal bleeding, which uniformly elicited a grave clinical course. Rout ine preoperative biliary drainage failed to enhance the security of PJ . Completion pancreatectomy continued to carry a poor prognosis, and s hould be avoided when possible and replaced by early, aggressive radio logic intervention. (C) 1997 Academic Press.