Review Dig Surg 1999;16:327–336 Prevention and Treatment of Complications in Pancreatic Cancer Surgery Pascal O. Berberat Helmut Friess Jörg Kleeff Waldemar Uhl Markus W. Büchler Department of Visceral and Transplantation Surgery, University of Bern, Inselspital, Bern, Switzerland M.W. Büchler, MD Department of Visceral and Transplantation Surgery University of Bern, Inselspital CH–3010 Bern (Switzerland) Tel. +41 31 632 2404, Fax +41 31 382 4772, E-Mail markus.buechler@insel.ch ABC Fax + 41 61 306 12 34 E-Mail karger@karger.ch www.karger.com © 1999 S. Karger AG, Basel 0253–4886/99/0164–0327$17.50/0 Accessible online at: http://BioMedNet.com/karger Key Words Postoperative complications W Fistulas W Hemorrhage W Delayed gastric emptying W Octreotide W Pancreatic cancer surgery W Pancreatic resection Summary Pancreatic cancer is the fourth leading cause of death from malignant disease in Western industrialized countries. It is a devastating disease with a very poor prognosis and has a death rate roughly equal to its incidence rate. As this tumor is resistant to all medical treatment options, such as radio- and chemotherapy, radical surgical resection is the only chance of cure so far. Significant advances have been made over the past decades in pancreaticoduodenecto- my, which is the standard operation in patients with pan- creatic head cancer or periampullary cancer. In specialized centers the operative mortality has fallen under 5%. How- ever, the postoperative complication rates after this de- manding procedure are still between 30 and 40%. Compli- cations are mainly due to the technical difficulty of per- forming a safe and proper anastomosis between the stom- ach or small bowel and the soft pancreas. This article reviews the treatment of the complications most frequent- ly occurring after pancreatic cancer surgery, such as leak- age of pancreatic anastomosis, pancreatic fistula, abscess and hemorrhage. Furthermore, we discuss the manage- ment of these complications and how complications fol- lowing pancreatic surgery can be prevented. Introduction Pancreatic cancer is the fourth leading cause of death from malignant disease in Western industrialized coun- tries. It is a devastating disease with a very poor prognosis and has a death rate roughly equal to its incidence rate [1, 2]. Contributing to the high death rate is the often late diag- nosis – at a stage when the tumor has already metastasized and the possibility of a curative resection is greatly reduced – and the unresponsiveness to conventional oncological treatment options. Although chemotherapy has improved prognosis in many malignancies, its impact on pancreatic cancer is limited [3]. The same is true of intraoperative or external radiotherapy, antihormonal treatment and immu- notherapy [4–7]. Due to the lack of effective adjuvant treat- ment protocols, the median survival time following diagno- sis in nonresectable tumors is only about 4–6 months. For cancers without distant metastases, resectability rates have increased steadily during the past several decades, due in part to improved diagnostic techniques and lower postoperative mortality and morbidity in expe- rienced centers of pancreatic surgery [8–17]. However, long-term survival after resection continues to be low. Recent studies indicate that the 5-year survival rate fol- lowing resection for pancreatic cancer is only around 10% [10–12], with a range between 0.4 and 33% [8–12]. Despite this, the fact remains that pancreatic resection represents the only chance for cure, and often also the best chance for palliation.