Research Progress on Common Complications after Pancreaticoduodenectomy

Abstract

Pancreaticoduodenectomy (PD), also known as pancreaticoduodenectomy, is a major surgical treatment for some severe hepatobiliary diseases. During the operation, not only is it necessary to explore the abdominal cavity for the patient, but also to help the patient with the resection of the duodenum and the reconstruction of the digestive tract. Each step is particularly important [1]. This surgery requires the resection of multiple organs and the completion of complex digestive tract reconstruction, with high operational difficulty and a high rate of postoperative complications. It is one of the most challenging surgeries in the field of abdominal surgery. Laparoscopic pancreaticoduodenectomy (LPD) was first reported by Gagner and Pomp in 1994. In the early stage, it was limited due to high postoperative complication and mortality rates, as well as no advantages in terms of hospital stay and cost [2]. LPD is one of the most complex laparoscopic surgeries, involving the resection of multiple organs, large surgical trauma, and complex digestive tract reconstruction steps, with a high incidence of postoperative complications. Therefore, in the early stage of LPD, its safety and effectiveness were widely questioned due to high postoperative mortality and severe complications. In recent years, with the improvement of laparoscopic techniques and the continuous update of surgical instruments, LPD has developed rapidly and has become a routine surgical method in some large pancreatic surgery centers in China [3]. Recent retrospective clinical studies have shown that LPD has the advantages of less bleeding and faster postoperative recovery, and its postoperative complication rate, mortality rate, and oncological treatment effect are similar to or even better than those of traditional open surgery [4-8]. Postoperative complications are very likely to occur in patients, and clinical studies suggest that this situation usually occurs within one week after surgery. Patients may experience significant abdominal distension, abdominal tenderness, and even a certain degree of high fever. An increase in the volume of abdominal drainage fluid can be found when performing abdominal drainage for the patient. If the amylase level in the patient’s abdominal drainage fluid increases, it can be confirmed that the patient has developed a pancreatic fistula. Generally, non-surgical methods are chosen for treatment. Different methods of digestive tract reconstruction also have their own value in preventing the occurrence of pancreatic fistula [9]. PD is a surgical operation with high technical difficulty, complex operation, and a high rate of postoperative complications. The classic Whipple procedure and various modified procedures have become safe and effective treatment methods. However, the high perioperative mortality rate has long hindered the promotion of this surgery [10]. With the improvement of surgical techniques, standardized perioperative care and complication management, the postoperative mortality rate of PD has dropped to less than 5% [11]. This has expanded its indications from pancreatic cancer to cystic tumors, neuroendocrine tumors, and other uncommon tumors. However, the overall perioperative complication rate of PD still ranges from 30% to 60%, which seriously affects the quality of life of patients and increases medical costs [12]. Accurate preoperative assessment and standardized surgical procedures can effectively reduce the incidence of postoperative complications [13]. Active, reasonable, and effective management of postoperative complications is crucial for improving the short-term prognosis of patients. This article systematically introduces common postoperative complications of PD based on domestic and foreign literature and the clinical experience of our center.