World Journal of Surgery

, Volume 43, Issue 2, pp 626–633 | Cite as

Risk Factors for Late-Onset Gastrointestinal Hemorrhage After Pancreatoduodenectomy for Pancreatic Cancer

  • Minako Nagai
  • Masayuki ShoEmail author
  • Takahiro Akahori
  • Satoshi Nishiwada
  • Kenji Nakagawa
  • Kota Nakamura
  • Toshihiro Tanaka
  • Hideyuki Nishiofuku
  • Kimihiko Kichikawa
  • Naoya Ikeda
Original Scientific Report



Late-onset gastrointestinal hemorrhage after pancreatoduodenectomy (PD) occasionally occurs repeatedly or leads to a serious condition. This retrospective study aimed to clarify its frequency and pathogenesis.


A total of 147 consecutive patients who underwent PD for pancreatic cancer between 2006 and 2014 were evaluated. Patients were divided into two groups according to the occurrence of late-onset gastrointestinal hemorrhage on postoperative day 100 or later. Furthermore, recurrence and portal vein (PV) hemodynamics were thoroughly reevaluated by computed tomography.


Eleven patients experienced late-onset gastrointestinal hemorrhage. The bleeding sites were gastrojejunostomy in four patients, choledochojejunostomy in two, transverse colic marginal vein in one, and unknown in four. The median occurrence time of late-onset gastrointestinal hemorrhage was 13.3 months after PD. PV occlusion (63.6 vs. 8.9%; p < 0.001), no patency of PV–splenic vein (SPV) confluence (54.5 vs. 12.7%; p = 0.002), and SPV ligation (36.4 vs. 9.6%; p = 0.025) were found to be significant risk factors for late-onset gastrointestinal hemorrhage. Among 11 patients who experienced late-onset gastrointestinal hemorrhage, 7 had PV occlusion and 6 had local recurrence.


Our data suggested for the first time that both oncologic and non-oncologic factors might contribute to late-onset gastrointestinal hemorrhage after PD for pancreatic cancer. Furthermore, PV occlusion, no PV–SPV patency, and SPV ligation were found to be significant risk factors for late-onset gastrointestinal hemorrhage. Therefore, to prevent late-onset gastrointestinal hemorrhage, we must consider various approaches to maintain the patency of the PV and SPV.



This study was supported in part by Nara Medical University Grant-in-Aid for Collaborative Research Projects.


Sources of funding for research and/or publication: This study was supported in part by Nara Medical University Grant-in-Aid for Collaborative Research Projects.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Minako Nagai
    • 1
  • Masayuki Sho
    • 1
    Email author
  • Takahiro Akahori
    • 1
  • Satoshi Nishiwada
    • 1
  • Kenji Nakagawa
    • 1
  • Kota Nakamura
    • 1
  • Toshihiro Tanaka
    • 2
  • Hideyuki Nishiofuku
    • 2
  • Kimihiko Kichikawa
    • 2
  • Naoya Ikeda
    • 1
  1. 1.Department of SurgeryNara Medical UniversityKashiharaJapan
  2. 2.Department of RadiologyNara Medical UniversityKashiharaJapan

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