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Predictors of 90-day morbidity and mortality after Frey procedure for chronic pancreatitis

  • Sukanta Ray
    Correspondence
    Corresponding author. Division of GI Surgery, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India.
    Footnotes
    Affiliations
    Division of GI Surgery, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
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  • Arkadeep Dhali
    Correspondence
    Corresponding author.
    Footnotes
    Affiliations
    Division of GI Surgery, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
    Search for articles by this author
  • Zuber Ansari
    Affiliations
    Division of GI Surgery, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
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  • Arunesh Gupta
    Affiliations
    Division of GI Surgery, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
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  • Sreecheta Mukherjee
    Affiliations
    Division of GI Surgery, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
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  • Suman Das
    Affiliations
    Division of GI Surgery, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
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  • Somak Das
    Affiliations
    Division of GI Surgery, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
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  • Tuhin Subhra Mandal
    Affiliations
    Division of GI Surgery, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
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  • Jayanta Biswas
    Affiliations
    Division of GI Surgery, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
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  • Sujan Khamrui
    Affiliations
    Division of GI Surgery, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
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  • Gopal Krishna Dhali
    Affiliations
    Division of Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India
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  • Author Footnotes
    1 SR and AD contributed as joint first authors.
Published:October 12, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.10.013

      Highlights

      • Frey procedure is associated with acceptable perioperative morbidity and a low mortality.
      • Postoperative major complications developed in 12% of patients.
      • Duration of CP & blood transfusions were independent predictors of postoperative complications.

      Abstract

      Background

      The literature on predictors for postoperative complications after Frey procedure (FP) is sparse. The aim of this study is to report our experience with 90-day complications of FP and predictors for complications.

      Methods

      All patients with chronic pancreatitis (CP), who underwent a FP between August 2007 and July 2021, were retrospectively reviewed. Univariate and multivariate analysis were used to identify predictors of 90-day morbidity and mortality.

      Results

      Of the total 270 patients, 84 (31%) patients developed at least one postoperative complication. Major complications occurred in 32 (12%) patients. Most common complication was wound infection and it was significantly more common in stented patients (p = 0.017). Pancreatic fistula and post pancreatectomy hemorrhage (PPH) developed in 7.4% of patients. Thirteen patients (4.8%) required early re-operation and the most common cause of re-exploration was PPH. 90-day mortality was 1% (n = 3) and all 3 patients required re-exploration for PPH. Median postoperative hospital stay was 9 (5–51) days. Perioperative blood transfusions was the only independent predictor of postoperative complications after FP.

      Conclusions

      Frey procedure is an acceptable treatment modality with low rates of mortality and reasonable perioperative morbidities. Minimizing blood transfusions may further improve 90-day outcomes.

      Keywords

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      References

        • Negi S.
        • Singh A.
        • Chaudhary A.
        Pain relief after Frey's procedure for chronic pancreatitis.
        Br J Surg. 2010 Jul; 97 (PMID: 20632276): 1087-1095https://doi.org/10.1002/bjs.7042
        • Friess H.
        • Berberat P.O.
        • Wirtz M.
        • Büchler M.W.
        Surgical treatment and long-term follow-up in chronic pancreatitis.
        Eur J Gastroenterol Hepatol. 2002 Sep; 14 (PMID: 12352216): 971-977https://doi.org/10.1097/00042737-200209000-00007
        • Liao Q.
        • Wu W.W.
        • Li B.L.
        • Zhang T.P.
        • Zhao Y.P.
        Surgical treatment of chronic pancreatitis.
        Hepatobiliary Pancreat Dis Int. 2002 Aug; 1 (PMID: 14607728): 462-464
        • Dua M.M.
        • Visser B.C.
        Surgical approaches to chronic pancreatitis: indications and techniques.
        Dig Dis Sci. 2017 Jul; 62 (Epub 2017 Mar 9. PMID: 28281166): 1738-1744https://doi.org/10.1007/s10620-017-4526-x
        • Tillou J.D.
        • Tatum J.A.
        • Jolissaint J.S.
        • et al.
        Operative management of chronic pancreatitis: a review.
        Am J Surg. 2017 Aug; 214 (Epub 2017 Mar 14. PMID: 28325588): 347-357https://doi.org/10.1016/j.amjsurg.2017.03.004
        • Frey C.F.
        • Amikura K.
        Local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy in the management of patients with chronic pancreatitis.
        Ann Surg. 1994 Oct; 220 (discussion 504-7) (PMID: 7524454; PMCID: PMC1234422): 492-504https://doi.org/10.1007/BF02348284
        • Pessaux P.
        • Kianmanesh R.
        • Regimbeau J.M.
        • et al.
        Frey procedure in the treatment of chronic pancreatitis: short-term results.
        Pancreas. 2006; 33: 354-358
        • Falconi M.
        • Bassi C.
        • Casetti L.
        • et al.
        Long-term results of Frey's procedure for chronic pancreatitis: a longitudinal prospective study on 40 patients.
        J Gastrointest Surg. 2006; 10: 504-510
        • Egawa S.
        • Motoi F.
        • Sakata N.
        • et al.
        Assessment of Frey procedures: Japanese experience.
        J Hepatobiliary Pancreat Sci. 2010 Nov; 17 (Epub 2009 Sep 30. PMID: 19789835): 745-751https://doi.org/10.1007/s00534-009-0185-4
        • Keck T.
        • Wellner U.F.
        • Riediger H.
        • et al.
        Long-term outcome after 92 duodenum-preserving pancreatic head resections for chronic pancreatitis: comparison of Beger and Frey procedures.
        J Gastrointest Surg. 2010; 14: 549-556
        • Gestic M.A.
        • Callejas-Neto F.
        • Chaim E.A.
        • Utrini M.P.
        • Cazzo E.
        • Pareja J.C.
        Surgical treatment of chronic pancreatitis using Frey's procedure: a Brazilian 16-year single-centre experience.
        HPB. 2011 Apr; 13 (Epub 2011 Mar 7. PMID: 21418132; PMCID: PMC3081627): 263-271https://doi.org/10.1111/j.1477-2574.2010.00281.x
        • Hildebrand P.
        • Duderstadt S.
        • Jungbluth T.
        • Roblick U.J.
        • Bruch H.P.
        • Czymek R.
        Evaluation of the quality of life after surgical treatment of chronic pancreatitis.
        JOP. 2011; 12: 364-371
        • Roch A.M.
        • Brachet D.
        • Lermite E.
        • Pessaux P.
        • Arnaud J.P.
        Frey procedure in patients with chronic pancreatitis: short and long-term outcome from a prospective study.
        J Gastrointest Surg. 2012; 16: 1362-1369
        • Tanaka M.
        • Matsumoto I.
        • Shinzeki M.
        • et al.
        Short- and long-term results of modified Frey's procedure in patients with chronic pancreatitis: a retrospective Japanese single-center study.
        Kobe J Med Sci. 2014 Aug 20; 60 (PMID: 25339257): E30-E36
        • Cauchy F.
        • Regimbeau J.M.
        • Fuks D.
        • Balladur P.
        • Tiret E.
        • Paye F.
        Influence of bile duct obstruction on the results of Frey's procedure for chronic pancreatitis.
        Pancreatology. 2014 Jan-Feb; 14 (Epub 2013 Oct 30. PMID: 24555975): 21-26https://doi.org/10.1016/j.pan.2013.10.008
        • Ueda J.
        • Miyasaka Y.
        • Ohtsuka T.
        • Takahata S.
        • Tanaka M.
        Short- and long-term results of the Frey procedure for chronic pancreatitis.
        J Hepatobiliary Pancreat Sci. 2015 Mar; 22 (Epub 2014 Oct 22. PMID: 25339262): 211-216https://doi.org/10.1002/jhbp.176
        • Chaudhary A.
        • Negi S.S.
        • Masood S.
        • Thombare M.
        Complications after Frey's procedure for chronic pancreatitis.
        Am J Surg. 2004 Sep; 188 (PMID: 15450834): 277-281https://doi.org/10.1016/j.amjsurg.2004.06.012
        • Merdrignac A.
        • Bergeat D.
        • Robin F.
        • et al.
        Impact of prior interventional treatment on the complications after Frey procedure for chronic pancreatitis.
        Langenbeck's Arch Surg. 2019 Nov; 404 (Epub 2019 Oct 25. PMID: 31654115): 825-830https://doi.org/10.1007/s00423-019-01832-8
        • Agha R.A.
        • Borrelli M.R.
        • Vella-Baldacchino M.
        • Thavayogan R.
        • Orgill D.P.
        • STROCSS Group
        The STROCSS statement: strengthening the reporting of cohort studies in surgery.
        Int J Surg. 2017; 46: 198-202https://doi.org/10.1016/j.ijsu.2017.08.586
        • Frey C.F.
        • Smith G.J.
        Description and rationale of a new operation for chronic pancreatitis.
        Pancreas. 1987; 2 (PMID: 3438308): 701-707https://doi.org/10.1097/00006676-198711000-00014
        • Dindo D.
        • Demartines N.
        • Clavien P.A.
        Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004 Aug; 240 (PMID: 15273542; PMCID: PMC1360123): 205-213https://doi.org/10.1097/01.sla.0000133083.54934.ae
        • Bassi C.
        • Marchegiani G.
        • Dervenis C.
        • et al.
        International study Group on pancreatic surgery (ISGPS). The 2016 update of the international study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years after.
        Surgery. 2017 Mar; 161 (Epub 2016 Dec 28. PMID: 28040257): 584-591https://doi.org/10.1016/j.surg.2016.11.014
        • Wente M.N.
        • Veit J.A.
        • Bassi C.
        • et al.
        Postpancreatectomy hemorrhage (PPH): an international study Group of pancreatic surgery (ISGPS) definition.
        Surgery. 2007 Jul; 142 (PMID: 17629996): 20-25https://doi.org/10.1016/j.surg.2007.02.001
        • Wente M.N.
        • Bassi C.
        • Dervenis C.
        • et al.
        Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS).
        Surgery. 2007 Nov; 142 (PMID: 17981197): 761-768https://doi.org/10.1016/j.surg.2007.05.005
        • Koch M.
        • Garden O.J.
        • Padbury R.
        • et al.
        Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery.
        Surgery. 2011 May; 149 (Epub 2011 Feb 12. PMID: 21316725): 680-688https://doi.org/10.1016/j.surg.2010.12.002
        • Sah D.N.
        • Bhandari R.S.
        • Singh Y.P.
        • et al.
        Early outcome of Frey's procedure for chronic pancreatitis: Nepalese tertiary center experience.
        BMC Surg. 2019 Sep 18; 19 (PMID: 31533694; PMCID: PMC6751617): 139https://doi.org/10.1186/s12893-019-0592-7
        • Martin E.T.
        • Kaye K.S.
        • Knott C.
        • et al.
        Diabetes and risk of surgical site infection: a systematic review and meta-analysis.
        Infect Control Hosp Epidemiol. 2016 Jan; 37 (Epub 2015 Oct 27. PMID: 26503187; PMCID: PMC4914132): 88-99https://doi.org/10.1017/ice.2015.249
        • Zhou Y.
        • Shi B.
        • Wu L.
        • Wu X.
        • Li Y.
        Frey procedure for chronic pancreatitis: evidence-based assessment of short- and long-term results in comparison to pancreatoduodenectomy and Beger procedure: a meta-analysis.
        Pancreatology. 2015 Jul-Aug; 15 (Epub 2015 May 27. PMID: 26055537): 372-379https://doi.org/10.1016/j.pan.2015.05.466
        • Ejaz A.
        • Spolverato G.
        • Kim Y.
        • Frank S.M.
        • Pawlik T.M.
        Variation in triggers and use of perioperative blood transfusion in major gastrointestinal surgery.
        Br J Surg. 2014 Oct; 101 (Epub 2014 Aug 5. PMID: 25091410): 1424-1433https://doi.org/10.1002/bjs.9617
        • Rohde J.M.
        • Dimcheff D.E.
        • Blumberg N.
        • et al.
        Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis.
        JAMA. 2014 Apr 2; 311 (Erratum in: JAMA. 2014 Nov 19;312(19):2045. PMID: 24691607; PMCID: PMC4289152): 1317-1326https://doi.org/10.1001/jama.2014.2726
        • Glance L.G.
        • Dick A.W.
        • Mukamel D.B.
        • et al.
        Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery.
        Anesthesiology. 2011 Feb; 114 (PMID: 21239971): 283-292https://doi.org/10.1097/ALN.0b013e3182054d06
        • Bernard A.C.
        • Davenport D.L.
        • Chang P.K.
        • Vaughan T.B.
        • Zwischenberger J.B.
        Intraoperative transfusion of 1 U to 2 U packed red blood cells is associated with increased 30-day mortality, surgical-site infection, pneumonia, and sepsis in general surgery patients.
        J Am Coll Surg. 2009 May; 208 (931-937, 937.937-2; discussion 938-9) (Epub 2009 Mar 26. PMID: 19476865)https://doi.org/10.1016/j.jamcollsurg.2008.11.019
        • Napolitano M.
        • Brody F.
        • Lee K.B.
        • et al.
        30-Day outcomes and predictors of complications after Puestow procedure.
        Am J Surg. 2020 Aug; 220 (Epub 2019 Dec 25. PMID: 31894016): 372-375https://doi.org/10.1016/j.amjsurg.2019.12.024