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Langenbeck's Archives of Surgery

, Volume 403, Issue 8, pp 949–957 | Cite as

Risk for hemorrhage after pancreatoduodenectomy with venous resection

  • Dyre KleiveEmail author
  • Mushegh Sahakyan
  • Kjetil Søreide
  • Kristoffer W. Brudvik
  • Pål-Dag Line
  • Ivar P. Gladhaug
  • Knut Jørgen Labori
ORIGINAL ARTICLE
  • 117 Downloads

Abstract

Purpose

No consensus exists on the optimal anticoagulation therapy after pancreatoduodenectomy with venous resection (PDVR). The aim of the study was to analyze perioperative outcomes of patients receiving low- vs high-dose anticoagulation therapy and to identify risk factors for postpancreatectomy hemorrhage in patients undergoing PDVR.

Methods

Retrospective study of patients undergoing PDVR at a tertiary referral center between January 2006 and April 2017. Patients were investigated according to the dose of postoperative anticoagulation given (low- or high-dose low-molecular-weight heparin). Uni- and multivariate analysis were performed to assess risk factors for postpancreatectomy hemorrhage.

Results

A total of 141 patients underwent PDVR. Low-dose anticoagulation was given to 45 (31.9%) patients. Operative time (428 min vs 398 min, p = 0.025) and the use of interposition grafts (27% vs 11%, P = 0.033) were significantly higher in the high-dose group. There was no difference in the rate of early portal vein thrombosis (4.4% vs 4.2%, p = 0.939) or postpancreatectomy hemorrhage (13.3% vs 16.7%, p = 0.611) between the low- and high-dose groups. On multivariate analysis, serum bilirubin ≥ 200 μmol/L and clinically relevant postoperative fistula were the only factors associated with postpancreatectomy hemorrhage (OR 10.28, 95% CI 3.51–30.07, P < 0.001, and OR 6.39, 95% CI 1.59–25.74, P = 0.009).

Conclusion

Preoperative hyperbilirubinemia and clinically relevant postoperative fistula are risk factors for postpancreatectomy hemorrhage after PDVR. Rates of postpancreatectomy hemorrhage did not differ between patients receiving high- vs low-dose low-molecular-weight heparin.

Keywords

Pancreatoduodenectomy with venous resection Anticoagulation policy 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was not obtained by all participants. The study was permitted by the hospital review board in accordance with the regional ethical committee.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Hepato-Pancreato-Biliary SurgeryOslo University Hospital, RikshospitaletOsloNorway
  2. 2.Institute of Clinical MedicineUniversity of OsloOsloNorway
  3. 3.Department of Surgery N1Yerevan State Medical University after M. HeratsiYerevanArmenia
  4. 4.The Intervention CenterOslo University Hospital, RikshospitaletOsloNorway
  5. 5.Department of Gastrointestinal SurgeryStavanger University HospitalStavangerNorway
  6. 6.Clinical SurgeryRoyal Infirmary of Edinburgh and University of EdinburghEdinburghUK
  7. 7.Department of Clinical MedicineUniversity of BergenBergenNorway
  8. 8.Institute of Transplantation MedicineOslo University Hospital, RikshospitaletOsloNorway

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