Complications After Pancreaticoduodenectomy: Analysis of Risk Factors, Their Incidence, and Possible Prevention in Italy

Summary

Pancreaticoduodenectomy is unquestionably the most difficult operation in major pancreatic surgery as the result of both problems posed by perioperative management of the patients and the particular anatomical relationships of the pancreas. Over the years, many studies have analyzed the factors influencing the success or failure of this procedure, but all of these are retrospective and inevitably reflect the particular experience of single centers. It may be noted that pancreatic enzymes are separated biologically and physically from their activators. The surgical operations performed in this sector, and particularly pancreaticoduodenectomy, thus disrupt the normal anatomical situation and increase the risk of postoperative complications. One distinct possibility, irrespective of the surgeon’s experience and expertise, the degree of fibrosis of the pancreas, and the metabolic status of the patient, hinges upon the feasibility of intervening by specifically reducing pancreatic exocrine secretion. To assess this aspect, a prospective Italian multicenter study has evaluated the occurrence of complications in the course of treatment with Octreotide at subcutaneous doses of 100 μg three times daily versus a placebo. This study reveals that the use of Octreotide induces a significant mean reduction, roughly 50%, in the risk of pancreatic fistula formation as compared to placebo. All in all, however, the results are still disappointing, as the post-pancreaticoduodenectomy morbidity rate ranges from 16% to 32% of the various case series analyzed.