Surgical events and outcomes
pancreatic leak, duodenal bleed, ileus
PULMONARY EMBOLISM, GASTROINTESTINAL BLEED, RADIATION ENTERITIS, WOUND INFECTION, FAILURE TO THRIVE, CARDIAC ARREST, DELAYED GASTRIC EMPTYING, ILEUS
Among the 11 patients who underwent definitive resection, eight (73%) had R0 resection, and three (27%) had R1 resection where the surgical margin was positive microscopically. Six had standard pancreaticoduodenectomy, two had pylorus‐preserving pancreaticoduodenectomy, one had radical antegrade modular pancreaticosplenectomy, one had posterior radical antegrade pancreaticosplenectomy, and one had distal pancreatectomy with splenectomy. Peritoneal deposit was completely resected in one patient, and intraoperative radiation was utilized in another patient. Two patients had a positive margin detected on the superior mesenteric vein margin, and one patient had both positive pancreatic neck and splenic vein margins. Thus, the final R0 resection was eight of 19 (42%, 95% confidence interval [CI] 20%–67%), which met the original criteria for the study to continue beyond Stage 1 to the intended full sample size, before the multidisciplinary team investigators and sponsor terminated the study.Hospitalization for the 11 resected patients ranged from 6 to 17 days with median of 10 days, with pancreatic leak, ileus, wound infection, and delayed gastric emptying as common reasons for prolonged hospitalizations. Four of 11 patients were readmitted within 30 days (two having failure to thrive, one with delayed gastric emptying, and one with wound infection). One patient was hospitalized six times during the postoperative 90‐day period and ultimately was thought to have radiation enteritis leading to gastrointestinal bleed, pulmonary embolism, failure to thrive, and worsening functional decline, which led to this patient transitioning to hospice. Another patient was rehospitalized within 90 days, but after administration of the first postoperative chemotherapy, for duodenal bleed from gastroduodenal artery stump causing temporary cardiac arrest. This was reversed after resuscitation with massive transfusions and interventional radiology embolization. This patient was able to resume postoperative chemotherapy upon recovery.