Completion pancreatectomy for surgical complications after pancreaticoduodenectomy

Significant complications continue to occur in a minority of patients undergoing pancreaticoduodenectomy; these frequently have fatal consequences. Analysis of 458 patients undergoing the Whipple procedure in this institution from 1972 to 1994 revealed that 16 patients with malignant periampullary tumours (ampullary, eight; pancreatic, seven; bile duct, one), and one patient with chronic pancreatitis subsequently required completion pancreatectomy. Postoperative difficulties after pancreaticoduodenectomy and indications for re-exploration were multifactorial: leakage (n = 8), pancreatitis (n = 7), bleeding (n = 1), and a delayed report of cancer at the margin of the pancreatic transection (n = 1). Completion pancreatectomy was often difficult (mean operating time 2.7 h, mean estimated blood loss 1897 ml). There was considerable significant postoperative morbidity (41 per cent) and mortality (24 per cent) after completion pancreatectomy. Patients who survived completion 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 more than 8 years after resection. Re-exploration and subsequent completion pancreatectomy after pancreaticoduodenectomy is rarely necessary, but if clinical manifestations occur secondary to failure of the pancreaticojejunostomy, early surgical intervention may maximize survival.