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Management and outcomes of hemorrhage after distal pancreatectomy: a multicenter study at high volume centers.
Duclos, Côme; Durin, Thibault; Marchese, Ugo; Sauvanet, Alain; Laurent, Christophe; Ayav, Ahmet; Turrini, Olivier; Sulpice, Laurent; Addeo, Pietro; Souche, François R; Perinel, Julie; Birnbaum, David J; Facy, Olivier; Gagnière, Johan; Gaujoux, Sébastien; Schwarz, Lilian; Regenet, Nicolas; Iannelli, Antonio; Regimbeau, Jean M; Piessen, Guillaume; Lenne, Xavier; El Amrani, Mehdi; Heyd, Bruno; Doussot, Alexandre.
Afiliação
  • Duclos C; Department of Digestive Surgical Oncology, Liver Transplantation Unit. CHU Besançon, Besançon, France.
  • Durin T; Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France.
  • Marchese U; Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Hospital, AP-HP, Paris, France.
  • Sauvanet A; Department of HPB Surgery, Hôpital Beaujon, University of Paris, Clichy, France.
  • Laurent C; Department of Digestive Surgery, Centre Magellan - CHU Bordeaux, Bordeaux, France.
  • Ayav A; Department of HPB Surgery, Nancy University Hospital, Nancy, France.
  • Turrini O; Institut Paoli Calmettes, Marseille University, Department of Oncological Surgery, Marseille, France.
  • Sulpice L; Department of Hepatobiliary and Digestive Surgery, University Hospital, Rennes 1 University, Rennes, France.
  • Addeo P; Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France.
  • Souche FR; Department of Surgery, Hopital Saint Eloi, Montpellier, France.
  • Perinel J; Department of Digestive Surgery, Hopital Edouard Herriot, Lyon, France.
  • Birnbaum DJ; Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France.
  • Facy O; Department of Digestive and Surgical Oncology, University Hospital, Dijon, France.
  • Gagnière J; Department of Digestive and Hepatobiliary Surgery - Liver Transplantation, University Hospital Clermont-Ferrand, Clermont-Ferrand, France.
  • Gaujoux S; Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.
  • Schwarz L; Department of Digestive Surgery, Rouen University Hospital and Université de Rouen Normandie, F-76100, Rouen, France.
  • Regenet N; Department of Digestive Surgery, Nantes Hospital, Nantes, France.
  • Iannelli A; Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Nice, France.
  • Regimbeau JM; Department of Digestive Surgery, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France.
  • Piessen G; Department of Digestive and Oncological Surgery, CHU Lille, Claude Huriez University Hospital, F-59000, Lille, France.
  • Lenne X; Medical Information Department, Lille University Hospital, Lille, France.
  • El Amrani M; Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France.
  • Heyd B; Department of Digestive Surgical Oncology, Liver Transplantation Unit. CHU Besançon, Besançon, France.
  • Doussot A; Department of Digestive Surgical Oncology, Liver Transplantation Unit. CHU Besançon, Besançon, France. Electronic address: adoussot@chu-besancon.fr.
HPB (Oxford) ; 26(2): 234-240, 2024 Feb.
Article em En | MEDLINE | ID: mdl-37951805
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.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Pancreatectomia / Pancreaticoduodenectomia Limite: Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Pancreatectomia / Pancreaticoduodenectomia Limite: Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article