Postoperative biological and clinical outcomes following uncomplicated pancreaticoduodenectomy.
10.14701/kjhbps.2016.20.1.23
- Author:
Emilie LERMITE
1
;
Tao WU
;
Alain SAUVANET
;
Christophe MARIETTE
;
Francois PAYE
;
Fabrice MUSCARI
;
Antonio Sa CUNHA
;
Bernard SASTRE
;
Jean Pierre ARNAUD
;
Patrick PESSAUX
Author Information
1. Service de Chirurgie digestive, Hopital universitaire d'Angers - Universite d'Angers, France.
- Publication Type:Original Article
- Keywords:
Pancreaticoduodenectomy;
Complication;
Natural history;
Biological test
- MeSH:
Alkaline Phosphatase;
Bilirubin;
Critical Pathways;
Follow-Up Studies;
gamma-Glutamyltransferase;
Humans;
Length of Stay;
Leukocyte Count;
Natural History;
Pancreaticoduodenectomy*;
Postoperative Period;
Prospective Studies;
Retrospective Studies
- From:Korean Journal of Hepato-Biliary-Pancreatic Surgery
2016;20(1):23-31
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUNDS/AIMS: The aim of this study was to describe clinical and biological changes in a group of patients who underwent pancreaticoduodenectomy (PD) without any complication during the postoperative period. These changes reflect the "natural history" of PD, and a deviation should be considered as a warning sign. METHODS: Between January 2000 and December 2009, 131 patients underwent PD. We prospectively collected and retrospectively analyzed demographic data, pathological variables, associated pathological conditions, and preoperative, intraoperative, and postoperative variables. Postoperative variables were validated using an external prospective database of 158 patients. RESULTS: The mean postoperative length of hospital stay was 20.3+/-4 days. The mean number of days until removal of nasogastric tube was 6.3+/-1.6 days. The maximal fall in hemoglobin level occurred on day 3 and began to increase after postoperative day (POD) 5, in patients with or without transfusions. The white blood cell count increased on POD 1 and persisted until POD 7. There was a marked rise in aminotransferase levels at POD 3. The peak was significantly higher in patients with hepatic pedicle occlusion (866+/-236 IU/L versus 146+/-48 IU/L; p<0.001). For both gamma-glutamyl transpeptidase and alkaline phosphatase, there was a fall on POD1, which persisted until POD 5, followed with a stabilization. Bilirubin decreased progressively from POD 1 onwards. CONCLUSIONS: This study facilitates a standardized biological and clinical pathway of follow-up. Patients who do not follow this recovery indicator could be at risk of complications and additional exams should be made to prevent consequences of such complications.
