Complications after resection of biliopancreatic cancer

During the past decade the mortality after pancreaticoduodenectomy decrease d to 0-4% in centers with experience. The morbidity however remains high al though a decrease has also been demonstrated. Leakage of the pancreatic ana stomosis is the most severe complication associated with a high mortality r eported between 8-40%. Resection of the pancreatic remnant is the most radi cal treatment but unfortunately associated with insulin dependent diabetes. Subtotal resection of the pancreas tail seems an alternative. The incidenc e of postoperative bleeding is decreasing in particular bleeding from ulcer s. Bleeding from a pseudo-aneurysm (2%) is leading to a high mortality up t o 50% and early aggressive intervention is mandatory. Delayed gastric empty ing is reported between 20-30%, the pathofysiology is still unknown but pos toperative intra-abdominal complications proved to be a risk factor. It is now evident that mortality is strongly related with hospital experience and regionalization reduced overall mortality. These findings are arguments to favour centralization of surgery for biliopancreatic cancer.