Postoperative biological and clinical outcomes following uncomplicated pancreaticoduodenectomy

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 demo-graphic data, pathological variables, associated pathological conditions, and preoperative, intraoperative, and post-operative 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 γ-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 stand-ardized 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. (Korean J Hepatobiliary Pancreat Surg 2016;20:23-31)