Gastroduodenopancreatectomia: análise da morbidade e mortalidade

Abstract

Objective: To determine the major complications in patients undergoing gastroduodenopancreatectomy for pancreatic cancer and periampullary region, possible determinant factors and associated mortality. Methods: Retrospective study including patients diagnosed with pancreatic cancer and periampullary region undergone GDP from January 1987 to December 2007. Epidemiological and clinical data, laboratory and disease-related data and the procedure were reviewed. Results: 105 patients were included. Males represented 52%. Signs and/or symptoms more frequent were pain and jaundice. Jaundice was observed in 78.89%. Most didn´t have diabetes, and the use of alcohol and smoke was less frequent. Most were submitted to classical resection with median operative time of 440 minutes. Duct-to-mucosa pancreatic reconstruction was carried out in 69 patients. Complications were observed in 54 patients (51.4%). The mortality rate was 7.6% (eight patients). Pancreatic fistula was observed in 21 cases (20%), with 9 cases (8.5%) grade A, 2 (1.9%) grade B, and 10 (9.5%) grade C. Other complications observed were biliary fistula (5.7%), operative wound infection (5.7%), intraabdominal abscess/collection (5.7%) and hemoperitoneum (2.8%). Clinical complications observed were pneumonia (3.8%) and urinary tract infection (1.9%). High CA 19-9 tumor marker and duct-to-mucosa pancreatic enteric reconstruction technique presented a statistically significant result. Conclusion: Pancreatic fistula remains the most important complication associated with higher mortality. The surgical technique used and CA 19-9 were prognostic factors. In this study, the pancreatic reconstruction technique using ductto-mucosa anastomosis type presented less failure.