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

IntroductionThe 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.MethodsThis 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.ResultsThe 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).ConclusionWhile 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 evidenceIV, Multicenter retrospective comparative study.