Pancreaticoduodenectomy in trauma patients with grade IV–V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial
Authors: Choron Rachel Leah , Piplani Charoo , Kuzinar Julia , Teichman Amanda L , Bargoud Christopher , Sciarretta Jason D , Smith Randi N , Hanos Dustin , Afif Iman N , Beard Jessica H , Dhillon Navpreet Kaur , Zhang Ashling , Ghneim Mira , Devasahayam Rebekah , Gunter Oliver , Smith Alison A , Sun Brandi , Cao Chloe S , Reynolds Jessica K , Hilt Lauren A , Holena Daniel N , Chang Grace , Jonikas Meghan , Echeverria-Rosario Karla , Fung Nathaniel S , Anderson Aaron , Fitzgerald Caitlin A , Dumas Ryan Peter , Levin Jeremy H , Trankiem Christine T , Yoon JaeHee , Blank Jacqueline , Hazelton Joshua P , McLaughlin Christopher J , Al-Aref Rami , Kirsch Jordan Michael , Howard Daniel S , Scantling Dane R , Dellonte Kate , Vella Michael A , Hopkins Brent , Shell Chloe , Udekwu Pascal , Wong Evan G , Joseph Bellal , Lieberman Howard , Ramsey Walter A , Stewart Collin H , Alvarez Claudia , Berne John D , Nahmias Jeffry , Puente Ivan , Patton Joe , Rakitin Ilya , Perea Lindsey , Pulido Odessa , Ahmed Hashim , Keating Jane , Kodadek Lisa M , Wade Jason , Henry Reynold , Schreiber Martin , Benjamin Andrew , Khan Abid , Mann Laura K , Mentzer Caleb , Mousafeiris Vasileios , Mulita Francesk , Reid-Gruner Shari , Sais Erica , Foote Christopher W , Palacio Carlos H , Argandykov Dias , Kaafarani Haytham , Bover Manderski Michelle T , Moko Lilamarie , Narayan Mayur , Seamon Mark 
Published: December 2024

Introduction

The utility of pancreaticoduodenectomy (PD) for high-grade traumatic injuries remains unclear and data surrounding its use are limited. We hypothesized that PD does not result in improved outcomes when compared with non-PD surgical management of grade IV–V pancreaticoduodenal injuries.

Methods

This is a retrospective, multicenter analysis from 35 level 1 trauma centers from January 2010 to December 2020. Included patients were ≥15 years of age with the American Association for the Surgery of Trauma grade IV–V duodenal and/or pancreatic injuries. The study compared operative repair strategy: PD versus non-PD.

Results

The sample (n=95) was young (26 years), male (82%), with predominantly penetrating injuries (76%). There was no difference in demographics, hemodynamics, or blood product requirement on presentation between PD (n=32) vs non-PD (n=63). Anatomically, PD patients had more grade V duodenal, grade V pancreatic, ampullary, and pancreatic ductal injuries compared with non-PD patients (all p<0.05). 43% of all grade V duodenal injuries and 40% of all grade V pancreatic injuries were still managed with non-PD. One-third of non-PD duodenal injuries were managed with primary repair alone. PD patients had more gastrointestinal (GI)-related complications, longer intensive care unit length of stay (LOS), and longer hospital LOS compared with non-PD (all p<0.05). There was no difference in mortality or readmission. Multivariable logistic regression analysis determined PD to be associated with a 3.8-fold greater odds of GI complication (p=0.010) compared with non-PD. In a subanalysis of patients without ampullary injuries (n=60), PD patients had more anastomotic leaks compared with the non-PD group (3 (30%) vs 2 (4%), p=0.028).

Conclusion

While PD patients did not have worse hemodynamics or blood product requirements on admission, they sustained more complex anatomic injuries and had more GI complications and longer LOS than non-PD patients. We suggest that the role of PD should be limited to cases of massive destruction of the pancreatic head and ampullary complex, given the likely procedure-related morbidity and adverse outcomes when compared with non-PD management.

Level of evidence

IV, Multicenter retrospective comparative study.