الفهرس 
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Abstract
Pancreaticoduodenectomy (PD) remains the standard surgical
treatment for various pathologies of the pancreas and the periampullary
area. Nonetheless, PD remains a complicated surgical procedure that can
significantly impact a patient’s subsequent quality of life.
Aim of the study:
The aim of this study is to identify the preoperative and intra-operative
variables; to identify the factors that might contribute to serious
complications and mortality of patients after pancreaticoduodenectomy.
Method:
This is retrospective and prospective hospital based study that been
done on all patients who underwent pancreaticoduodenectomy in
National Liver Institute between the first of January 2008 till the end of
June 2013. Files of the all patients in the surgery department in National
Liver Institute will be revised to collect pre-operative and intra- operative
data as regard:
Age, Sex, Current smoking within last year, Alcohol intake, other
comorbidities (DM, CAD, and hypertension), Preoperative biliary
drainage (ERCP or PTD). Preoperative CBC, Albumin, Bilirubin (Total
& Direct), SGOT, SGPT, Alkaline phosphatase, GGT, Creatinine, Urea,
Blood sugar, Coagulation profile (PT, PTT & INR), Tumor markers
(CEA, CA 19.9), and serum amylase and lipase, were assessed.
Preoperative radiological values including abdominal ultrasound,
abdominal tri-phasic CT (type and size of the tumor, vascular invasion,
LN metastases, Liver or distant metastases), MRCP, ERCP, Ultrasound (EUS), Biopsy either radiological guided or EUS, Chest X- ray & CT,
were reported.
Operative variables including type of pancreaticoduodenectomy
(Standard or Pylorus-sparing), Blood transfusions, Operative time,
Lymph node status, Superior mesenteric vein or portal vein involvement,
Consistency of pancreas, type of anastomosis (pancreaticojejunostomy or
pancreaticogastrostomy), pancreatic duct stenting, PV resection and
anastomosis were assessed. Post-operative data including
Histopathological examination of the resected mass (Size of the tumor,
type of the tumor, resection margins) were involved in the study. During
the first six months after pancreaticoduodenectomy serious complications
and mortality will be considered as early outcome related to the operation
which includes: pancreatic leak, bile leak, delayed gastric emptying,
bleeding requiring, blood transfusion, re- exploration (cause, findings and
the procedure), and recurrence. Mortality: Hospital mortality: within 30
days after operation, Late mortality within the 1sth 6th months.
Results:
Between the first of January 2008 and the end of June 2013, 102
patients underwent pancreaticoduodenectomy at the National Liver
Institute, Menoufiya University.
As regard univariate analysis, the patient’s age is the only
preoperative variable found to be statistically significant with the
incidence of delayed gastric emptying (P value < 0.05).
As regard the univariate analysis of the intraoperative variables, the
consistency of the pancreas, pancreatic duct size, operative time and
blood loss were statistically significant with the incidence of pancreatic
leak. The Blood loss was significant with the incidence of bile leak. The type of pancreaticoenteric anastomosis, pancreatic duct size and tumor
size were significant with the incidence of delayed gastric emptying. The
operative time, blood loss and blood transfusion were significant with the
incidence of wound infection.
As regard univariate analysis, the only pathological variable found to
be statistically significant with the incidence of postoperative major
complications is the type of the origin of the tumor with the incidence of
postoperative bile leak.
As regard multivariate analysis, the origin of the tumor and blood loss
was significant with the incidence of postoperative bile leak. The blood
loss was significant with the postoperative wound infection.