From an institutional review of 103 pancreaticoduodenal resections (PDRs) performed during the period 1968-1981, risk factors and selection criteria of this procedure were evaluated. A total of 43.7% of the patients were operated on for benign lesions, mainly right-sided
chronic pancreatitis (35%); 56.3% of the interventions were performed for malignant disease, mainly
carcinoma of the periampullary region. Despite the absence of any selection, the hospital mortality in 103 consecutive PDRs only reached 10.6% for the whole group (11/103 patients) and 8.3% for the elective group (8/96 patients). Mortality was significantly influenced by age barrier over 65 years (p less than 0.0001) and by urgent degree of surgery (p less than 0.03). All three patients with
renal insufficiency had a fatal outcome after PDR. A total of 19.4% of the patients (20/103 patients) developed a surgical complication. The most important complication was
pancreatic fistula (15/103 patients, 14.5%) responsible for all digestive-related fatal outcomes (six patients). Surgical treatment of
pancreatic fistula (10 patients) is compromised by a high morbidity and a high mortality rate (50%). Postoperative morbidity as well as the incidence of the
pancreatic fistula were significantly influenced by the age of the patients over 65 years (p less than 0.01 and less than 0.001, respectively), and by the serum
bilirubin level over 6 mg/dl (p less than 0.002). The poor quality of the pancreatic tissue (p less than 0.03) and the urgent degree of the intervention (p less than 0.03) also raised the incidence of pancreatic leakage. Morbidity rate was more important in the malignant disease group (p less than 0.05). Corrected 5-year actuarial survival after PDR is excellent for ampullary
cancer, moderate for
chronic pancreatitis, and extremely poor for pancreatic and bile duct
carcinoma. The decision to perform PDR should be taken after evaluation of the aforementioned risk factors: the emergency, age, serum
bilirubin, quality of pancreatic tissue and
renal insufficiency, underlying disease, and psycho-social status of the patient.