Article
Author: Nahmias, Jeffry ; Mentzer, Caleb ; Benjamin, Andrew ; Joseph, Bellal ; Hanos, Dustin ; Shell, Chloe ; Hilt, Lauren A ; Vella, Michael A ; Jonikas, Meghan ; Howard, Daniel S ; Anderson, Aaron ; Devasahayam, Rebekah ; Schreiber, Martin ; Gunter, Oliver ; Dhillon, Navpreet Kaur ; Choron, Rachel Leah ; Cao, Chloe S ; Narayan, Mayur ; Palacio, Carlos H ; McLaughlin, Christopher J ; Fung, Nathaniel S ; Beard, Jessica H ; Teichman, Amanda L ; Berne, John D ; Mulita, Francesk ; Reid-Gruner, Shari ; Foote, Christopher W ; Scantling, Dane R ; Alvarez, Claudia ; Fitzgerald, Caitlin A ; Mousafeiris, Vasileios ; Udekwu, Pascal ; Sais, Erica ; Rakitin, Ilya ; Wade, Jason ; Sciarretta, Jason D ; Kirsch, Jordan Michael ; Kuzinar, Julia ; Stewart, Collin H ; Kaafarani, Haytham ; Holena, Daniel N ; Wong, Evan G ; Ramsey, Walter A ; Mann, Laura K ; Zhang, Ashling ; Piplani, Charoo ; Seamon, Mark ; Al-Aref, Rami ; Moko, Lilamarie ; Hopkins, Brent ; Bargoud, Christopher ; Trankiem, Christine T ; Smith, Alison A ; Blank, Jacqueline ; Pulido, Odessa ; Perea, Lindsey ; Khan, Abid ; Afif, Iman N ; Dellonte, Kate ; Hazelton, Joshua P ; Reynold, Henry ; Smith, Randi N ; Lieberman, Howard ; Kodadek, Lisa M ; Dumas, Ryan Peter ; Puente, Ivan ; Patton, Joe ; Keating, Jane ; Ghneim, Mira ; Levin, Jeremy H ; Reynolds, Jessica K ; Chang, Grace ; Argandykov, Dias ; Echeverria-Rosario, Karla ; Bover Manderski, Michelle T ; Yoon, JaeHee ; Sun, Brandi ; Ahmed, Hashim
IntroductionThe utility of pancreaticoduodenectomy (PD) for high-grade traumatic injuries remains unclear and data surrounding its use are limited. We hypothesized that PD does not result in improved outcomes when compared with non-PD surgical management of grade IV–V pancreaticoduodenal injuries.MethodsThis is a retrospective, multicenter analysis from 35 level 1 trauma centers from January 2010 to December 2020. Included patients were ≥15 years of age with the American Association for the Surgery of Trauma grade IV–V duodenal and/or pancreatic injuries. The study compared operative repair strategy: PD versus non-PD.ResultsThe sample (n=95) was young (26 years), male (82%), with predominantly penetrating injuries (76%). There was no difference in demographics, hemodynamics, or blood product requirement on presentation between PD (n=32) vs non-PD (n=63). Anatomically, PD patients had more grade V duodenal, grade V pancreatic, ampullary, and pancreatic ductal injuries compared with non-PD patients (all p<0.05). 43% of all grade V duodenal injuries and 40% of all grade V pancreatic injuries were still managed with non-PD. One-third of non-PD duodenal injuries were managed with primary repair alone. PD patients had more gastrointestinal (GI)-related complications, longer intensive care unit length of stay (LOS), and longer hospital LOS compared with non-PD (all p<0.05). There was no difference in mortality or readmission. Multivariable logistic regression analysis determined PD to be associated with a 3.8-fold greater odds of GI complication (p=0.010) compared with non-PD. In a subanalysis of patients without ampullary injuries (n=60), PD patients had more anastomotic leaks compared with the non-PD group (3 (30%) vs 2 (4%), p=0.028).ConclusionWhile PD patients did not have worse hemodynamics or blood product requirements on admission, they sustained more complex anatomic injuries and had more GI complications and longer LOS than non-PD patients. We suggest that the role of PD should be limited to cases of massive destruction of the pancreatic head and ampullary complex, given the likely procedure-related morbidity and adverse outcomes when compared with non-PD management.Level of evidenceIV, Multicenter retrospective comparative study.