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Pancreaticoduodenectomy in trauma patients with grade IV–V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial
Journal article   Open access   Peer reviewed

Pancreaticoduodenectomy in trauma patients with grade IV–V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial

Rachel Leah Choron, Charoo Piplani, Julia Kuzinar, Amanda L Teichman, Christopher Bargoud, Jason D Sciarretta, Randi N Smith, Dustin Hanos, Iman N Afif, Jessica H Beard, …
Trauma surgery & acute care open, v 9(1), e001438
20 Dec 2024
DOI: https://doi.org/10.1136/tsaco-2024-001438
PMID: 39717488
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1136/tsaco-2024-001438View
Published, Version of Record (VoR) Open

Abstract

Original Research
<p>Introduction The 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. Methods This 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. Results The 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). Conclusion While 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 evidence IV, Multicenter retrospective comparative study.</p>

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Collaboration types
Domestic collaboration
International collaboration
Web of Science research areas
Critical Care Medicine
Surgery
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