Management and outcomes of hemorrhage after distal pancreatectomy: a multicenter study at high volume centers - Archive ouverte HAL
Article Dans Une Revue HPB Année : 2023

Management and outcomes of hemorrhage after distal pancreatectomy: a multicenter study at high volume centers

Ugo Marchese
Sébastien Gaujoux
Guillaume Piessen
Célia Turco
  • Fonction : Auteur
Safi Dokmak
  • Fonction : Auteur
Zineb Cherkaoui
David Fuks
  • Fonction : Auteur
Marie André
  • Fonction : Auteur
Ahmet Ayav
  • Fonction : Auteur
Cloé Magallon
  • Fonction : Auteur
Fabien Robin
  • Fonction : Auteur
Philippe Bachellier
  • Fonction : Auteur
Thomas Bardol
  • Fonction : Auteur
Mustapha Adham
  • Fonction : Auteur
Stylianos Tzedakis
  • Fonction : Auteur
Zaher Lakkis
  • Fonction : Auteur
Ecoline Tribillon
  • Fonction : Auteur
Edouard Roussel
  • Fonction : Auteur
Louise Barbier
  • Fonction : Auteur
Guillaume Piessen
  • Fonction : Auteur
Stéphanie Truant
  • Fonction : Auteur

Résumé

Background: Data on clinically relevant post-pancreatectomy hemorrhage (CR-PPH) are derived from series mostly focused on pancreatoduodenectomy, and data after distal pancreatectomy (DP) are scarce. Methods: All non-extended DP performed from 2014 to 2018 were included. CR-PPH encompassed grade B and C PPH. Risk factors, management, and outcomes of CR-PPH were evaluated. Results: Overall, 1188 patients were included, of which 561 (47.2 %) were operated on minimally invasively. Spleen-preserving DP was performed in 574 patients (48.4 %). Ninety-day mortality, severe morbidity and CR-POPF rates were 1.1 % (n = 13), 17.4 % (n = 196) and 15.5 % (n = 115), respectively. After a median interval of 8 days (range, 0-37), 65 patients (5.5 %) developed CR-PPH, including 28 grade B and 37 grade C. Reintervention was required in 57 patients (87.7 %). CR-PPH was associated with a significant increase of 90-day mortality, morbidity and hospital stay (p < 0.001). Upon multivariable analysis, prolonged operative time and co-existing POPF were independently associated with CR-PPH (p < 0.005) while a chronic use of antithrombotic agent trended towards an increase of CR-PPH (p = 0.081). As compared to CR-POPF, the failure-to-rescue rate in patients who developed CR-PPH was significantly higher (13.8 % vs. 1.3 %, p < 0.001). Conclusion: CR-PPH after DP remains rare but significantly associated with an increased risk of 90-day mortality and failure-to-rescue.

Domaines

Chirurgie
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Dates et versions

hal-04321024 , version 1 (04-12-2023)

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Côme Duclos, Thibault Durin, Ugo Marchese, Alain Sauvanet, Christophe Laurent, et al.. Management and outcomes of hemorrhage after distal pancreatectomy: a multicenter study at high volume centers. HPB, 2023, ⟨10.1016/j.hpb.2023.10.008⟩. ⟨hal-04321024⟩
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