Hemorrhage Sites and Mitigation Strategies After Pancreaticoduodenectomy

作者：William Preston, Micaela L. Collins, Mithat Gönen, Timothy D. Murtha, Victor M. Rivera, Ryan Lamm, Michelle Schafer, Hooman Yarmohammadi, Anne M. Covey, Lynn A. Brody, Stephen R. Topper, Avinoam Nevler, Harish Lavu, Charles J. Yeo, Vinod P. Balachandran, Jeffrey A. Drebin, Kevin C. Soares, Alice C. Wei, T. Peter Kingham, Michael I. D’Angelica, William R. Jarnagin · 发表于：JAMA Surgery · 年份：2024 · DOI：10.1001/jamasurg.2024.1228 · 被引用次数：22 · 研究领域：Pancreatic and Hepatic Oncology Research、Gallbladder and Bile Duct Disorders、Pancreatitis Pathology and Treatment

Importance: Postpancreatectomy hemorrhage is an uncommon but highly morbid complication of pancreaticoduodenectomy. Clinical evidence often draws suspicion to the gastroduodenal artery stump, even without a clear source. Objective: To determine the frequency of gastroduodenal artery bleeding compared to other sites and the results of mitigation strategies. Design, Setting, and Participants: This cohort study involved a retrospective analysis of data for consecutive patients who had pancreaticoduodenectomy from 2011 to 2021 at Memorial Sloan Kettering Cancer Center (MSK) and Thomas Jefferson University Hospital (TJUH). Exposures: Demographic, perioperative, and disease-related variables. Main Outcomes and Measures: The incidence, location, treatment, and outcomes of primary (initial) and secondary (recurrent) hemorrhage requiring invasive intervention were analyzed. Imaging studies were re-reviewed by interventional radiologists to confirm sites. Results: Inclusion criteria were met by 3040 patients (n = 1761 MSK, n = 1279 TJUH). Patients from both institutions were similar in age (median [IQR] age at MSK, 67 [59-74] years, and at TJUH, 68 [60-75] years) and sex (at MSK, 814 female [46.5%] and 947 male [53.8%], and at TJUH, 623 [48.7%] and 623 male [51.3%]). Primary hemorrhage occurred in 90 patients (3.0%), of which the gastroduodenal artery was the source in 15 (16.7%), unidentified sites in 24 (26.7%), and non-gastroduodenal artery sites in 51 (56.7%). Secondary hemorrhage ...