COMPLETION PANCREATECTOMY FOR SURGICAL COMPLICATIONS AFTER PANCREATICODUODENECTOMY

Significant complications continue to occur in a minority of patients undergoing pancreaticoduodenectomy; these frequently have fatal conseq uences. Analysis of 458 patients undergoing the Whipple procedure in t his institution from 1972 to 1994 revealed that 16 patients with malig nant periampullary tumours (ampullary, eight; pancreatic, seven; bile duct, one), and one patient with chronic pancreatitis subsequently req uired completion pancreatectomy. Postoperative difficulties after panc reaticoduodenectomy and indications for re-exploration were multifacto rial: leakage (n = 8), pancreatitis (n = 7), bleeding (n = 1), and a d elayed report of cancer at the margin of the pancreatic transection (n = 1). Completion pancreatectomy was often difficult (mean operating t ime 2.7 h, mean estimated blood loss 1897 ml). There was considerable significant postoperative morbidity (41 per cent) and mortality (24 pe r cent) after completion pancreatectomy. Patients who survived complet ion pancreatectomy lived a mean of nearly 4 years (range 4 months to 9 .7 years, median 2.6 years). Tumour recurrence led to death in ten of 13 patients. Three patients remain alive and free of recurrence each m ore than 8 years after resection. Re-exploration and subsequent comple tion pancreatectomy after pancreaticoduodenectomy is rarely necessary, but if clinical manifestations occur secondary to failure of the panc reaticojejunostomy, early surgical intervention may maximize survival.