恶性肿瘤病人胰十二指肠切除术后胰瘘及胆瘘的防治

目的 总结恶性肿瘤病人胰十二指肠切除术（PD）主要并发症胰瘘、胆瘘的初步处理经验和体会,并探讨其防治措施。方法 对1998年1月至2003年1月间的20例PD术后并发胰瘘、胆瘘病例进行回顾性分析。结果 全组病例手术均获得成功。术后并发胰瘘2例,死亡1例;并发胆瘘2例,死亡1例;另1例死于肝肾综合症,余17例治愈出院。远期效果在进一步随访中。结论 术后并发胰瘘应以内科治疗为主,通过减少胰液的分泌,并且保持局部引流的通畅,多数胰瘘可治愈。术后并发胆漏,通过保持支架管及局部引流通畅,多可治愈,出现肝汁性腹膜炎时应考虑手术处理。     

改良胰腺空肠套入式吻合在胰十二指肠切除术中的应用

目的:比较在胰十二指肠切除术(PD)中,改良胰腺空肠套入式吻合与胰管空肠黏膜吻合两种胰肠吻合方式术后胰瘘等相关并发症的发生率.方法:回顾性分析2014年1月至2016年12月盛京医院胰腺内分泌外科实施的59例PD手术患者的临床资料,其中采用改良胰腺空肠套入式吻合35例,采用胰管空肠黏膜吻合24例,比较两组术后胰瘘等相关并发症的发生率.结果:比较改良胰腺空肠套入式吻合与胰管空肠黏膜吻合两种胰肠吻合方式,发现手术时间和术中出血比较无统计学差异;术后胰瘘等相关并发症指标、住院时间、死亡率等无统计学差异.结论:改良胰腺空肠套入式吻合与胰管空肠黏膜吻合相比,同样安全可靠,具有操作方便,易于掌握,胰肠吻合严密牢固的优点,尤其适用于胰管直径小的病人,值得临床应用.     

胰头十二指肠切除术中胰腺断端的处理方法

胰头十二指肠切除术（PD）是治疗胰腺恶性及某些良性疾病的主要方法。但是PD的术后并发症的发生率非常高,其中胰肠吻合口瘘（PF）是最常见、最危险的并发症之一。文献报道PF是影响胰腺术后死亡率的独立因素,而胰腺断端处理方法的选择可以影响胰瘘的发生。因此在处理胰腺断端时,术式的选择是相当重要的。正常胰腺组织柔软、脆弱且供血丰富,在与消化道直接缝合时,易使缝线处的胰腺组织撕裂是胰腺断端较难处理的原因之一。因此,正确的吻合方式可在一定程度上减少PF的发生。但是至今仍然没有一种吻合方式显示相对较好的预后,胰腺断端的吻合方式目前仍是一个值得探讨的问题。本文就目前国际常用的术式,即胰腺断端的处理方式及其手术的适应症和优缺点进行介绍,以期对降低PD术后胰瘘的发生和改善PD术后生活质量提出一定借鉴。     

胰十二指肠切除改良胰管空肠吻合预防胰瘘

目的: 分析胰十二指肠切除术(PD)胰管空肠端侧粘膜对粘膜及胰管空肠套入式吻合方式,以其预防术后胰瘘发生。 方法: 2003年1月～2007年1月回顾性分析25例PD的临床资料,残胰的重建方式分别按胰管空肠粘膜对粘膜套入式端侧吻合,胰管支撑管胰液体外引流。 结果: PD24例术后恢复顺利,未发生胰瘘;1例术后腹腔创面广泛渗血,多器官功能衰竭围手术期死亡,其余随访无远期并发症。 结论: PD胰管空肠端侧粘膜对粘膜套入式吻合有明显避免胰瘘及并发症的发生,真正临床应用价值有待更大量的对照随机前瞻性大样本研究才能作出正确可靠的评价。     

胰肠吻合和胰胃吻合在胰十二指肠切除术后临床疗效的Meta分析

目的以循证医学证据评价胰肠吻合(pancreaticojejunostomy,PJ)和胰胃吻合(pancreaticogastrostomy,PG)在胰十二指肠切除术(panereatieoduodenectomy,PD)后的临床疗效。方法通过计算机检索PubMed数据库、EMBASE、万方数据库、中国全文期刊数据库和维普数据库,并结合文献追溯的方法,收集关于胰肠吻合和胰胃吻合在胰十二指肠切除术后临床疗效的随机前瞻性对照试验（RCT)或非随机前瞻性对照试验（NRCT）,并按 Cochrane协作网推荐的方法对符合纳入标准的 6个研究共866例患者进行Meta分析,发表偏倚用漏斗图评估。结果Meta分析结果显示,与胰肠吻合组相比,胰胃吻合组能降低胰十二指肠切除术后胰瘘发生率（P=0.003）、术后并发症的发生率（P=0.04）和腹腔内积液的发生（P=0.01）,但两者在术后胆瘘发生率（P=0.08）和围手术期死亡率（P=0.14)方面差异均无统计学意义。结论在胰十二指肠切除术后胰瘘、术后并发症发生率及腹腔内积液等方面,PG优于PJ,但是两者在胆瘘及围手术期死亡率等方面,疗效相当。且纳入的研究存在选择偏倚、发表偏倚及测量偏倚的可能性,这势必会影响结果的论证强度,所以进一步结论需要更多高质量的随机对照试验来进一步探讨、论证。     

综合手术方式预防胰十二指肠切除术后早期并发症113例分析

目的: 探讨综合手术方式预防胰十二指肠切除术后早期并发症的价值。 方法: 分析2001年8月～2007年6月内蒙古医学院第一附属医院肝胆外科113例胰十二指肠切除术(PD)的临床资料,其中综合手术方式组36例(A组),其他手术方式组77例(B组)。两组间性别、年龄、术前清蛋白水平、血细胞比容、壶腹部周围癌的部位及类型、两组术前的血清胆红素水平均无统计学差异(P>0.05)。比较两组手术时间、术中出血量、术后住院天数、ICU护理天数、术后早期并发症(包括胰瘘、出血、胆瘘及腹腔感染等)的发生率及术后死亡率等。 结果: A组患者中出现早期并发症7例(19.4%),其中胰瘘、胆瘘、出血、腹腔感染等的总数为5例(13.8%),死亡1例((2.7%);B组患者中出现早期并发症45例(58.4%),其中胰瘘、胆瘘、出血、腹腔感染等发生的患者总数为38例(49.4%)。出现两种及两种以上并发症8例,死亡5例(6.5%)。A组术后住院天数、胰瘘的发生率及腹腔感染率均低于B组,差异具有显著性(P<0.05);A组手术时间、术中出血量及ICU护理天数高于B组,差异无显著性(P>0.05);A组出血、胆瘘及死亡率均低于B组,差异无显著性(P<0.05)。 结论: 综合手术方式能够降低胰十二指肠切除术后早期并发症的发生率,缩短患者住院时间。     

胰十二指肠切除术后胰瘘的原因及临床分析

目的 分析胰十二指肠切除术后胰瘘的原因及预防经验。方法 回顾分析1994～2003年行胰十二指肠切除术的63例患者的临床资料，对影响胰瘘发生的因素和采取的治疗方法进行总结。结果 胰瘘与吻合技术有关，胰瘘的发生与残胰断面的处理以及胰实质的坚硬度、胰管的直径有关；胰管内支撑引流可预防PD术后胰瘘。结论 胰管内支撑引流和良好的胰切面血供是预防PD术后胰瘘的关键。     

胰肠吻合方式对胰十二指肠切除术后胰瘘的影响

目的：探讨胰肠吻合方式对胰十二指肠切除术后胰瘘的影响。方法：回顾性分析2008年10月至2013年8 月天津医科大学肿瘤医院收治的145 例术前诊断为壶腹周围肿瘤行胰十二指肠切除术患者的临床资料。对影响术后胰瘘发生的相关因素进行统计分析。结果：本组患者中27例术后发生胰瘘。在4 种胰肠吻合方式中,胰管空肠黏膜吻合和Blumgart 吻合的胰瘘发生率低,且皆无C 级胰瘘。多因素分析应用Logistic回归,结果表明不同的胰肠吻合方式及性别为术后胰瘘发生的独立预后因素。结论：胰肠吻合方式是影响胰十二指肠切除术后胰瘘发生的危险因素。     

胰十二指肠切除术后早期并发症的防治

目的探讨胰十二指肠切除术后早期并发症的预防和治疗措施。方法回顾分析1989年1月至2008年12月间行胰十二指肠切除术的65例临床资料,分析术后早期并发症的发生原因。结果65例均行手术治疗。术后共发生早期并发症14例,其中胰瘘8例（发生率12．3％）,7例经腹腔持续低压吸引和全身营养支持后痊愈,另1例死亡;胆瘘1例;消化道出血3例,1例死亡;腹腔感染2例。结论胰十二指肠切除术手术难度高,重视术前术中有关因素是减少并发症和病死率的关键。     

术前NLR、LMR、PNI值对胰十二指肠切除术后胰瘘发生的预测价值

目的:探讨术前预后营养指数(PNI)、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、淋巴细胞/单核细胞比值(LMR)对患者因壶腹周围癌而行胰头十二指肠切除术后发生胰瘘的预测价值。方法:回顾性分析中国医科大学附属盛京医院收治的140例手术切除治疗的壶腹周围癌病例资料。采用受试者工作特征曲线(ROC)、多因素回归分析确定术前NLR、PLR、LMR、PNI对术后胰瘘的预测价值。结果:共筛选出30例术后临床胰瘘(B级瘘和C级瘘)患者,累积发生率为21.43%(30/140),其中C级瘘为8例,发生率为5.71%(8/140)。术前NLR、PLR、LMR、PNI预测术后胰瘘的最佳截断值分别为3.49、150.79、2.48、44.8。进一步行多因素回归分析得出术前合并糖尿病、NLR≥3.49、LMR<2.48及PNI<44.8是胰头十二指肠切除术后并发胰瘘的独立危险因素(P＜0.05)。术前高NLR(≥3.49)、低PNI(<44.8)的患者术后发生严重的C级胰瘘的可能更大(P＜0.05)。应用胰瘘风险评分系统(FRS)对患者进行分层,其中21例处于高风险层次,进一步分析得到处于高风险层次的患者当同时合并术前高NLR、低PNI与低LMR中多项不良因素时,术后胰瘘的发生率可显著升高(78.57%,P=0.016)。结论:术前高NLR、低LMR、低PNI对胰头十二指肠切除术后患者并发胰瘘具有一定的预测价值;术前NLR、PNI水平与胰瘘的严重程度等级(B级瘘、C级瘘)具有相关性;处于FRS评分高风险层次的PD患者,当同时合并术前高NLR、低PNI与低LMR中多项时,术后发生胰瘘的风险增高。     

Surgical treatment of pancreatic cancer: Currently debated topics on morbidity,mortality, and lymphadenectomy

This review will examine several aspects of pancreatic surgery. Over the past twenty years, the need for a standardized postoperative complication report after resective pancreatic surgery has led to the definition both of a postoperative complication severity score, a postoperative pancreatic fistula (POPF) severity grading, a fistula risk score (FRS) and a postoperative morbidity index to establish the burden of complications. Unfortunately, three problems have hindered the success of standardization: first, the failure to define a minimum postoperative follow-up period that needs to be reported; second, the lack of a clear definition of POPF-related morbidity and mortality; third, the often-incomplete reporting of postoperative complications. The debate on the extent of lymphadenectomy to associate to pancreaticoduodenectomy started in the late 1980s when, based on retrospective studies, Japanese surgeons reported better survival after extended” than after “standard” lymphadenectomy. Subsequently, eight prospective randomized controlled trials showed that “extended” lymphadenectomy offers no advantage over “standard” lymphadenectomy. Several consensus conference and reviews tried to define the optimal extent of lymphadenectomy to be associated to pancreaticoduodenectomy and distal pancreatectomy (DP). At least nineteen lymph nodes (LN) are required for optimal tumor staging, but eleven LN are considered the minimum to prevent under staging. There is no general agreement about aborting PD in LN16-positive patients; some authors perform PD in fit patients. Based on retrospective studies, a significant increase of R0 resections, a decrease of recurrence rate, a decrease of local recurrence rate and an increase of median or overall disease-free survival were reported after mesopancreas excision.     

Reconstruction after pancreatoduodenectomy: Pancreatojejunostomy vs pancreatogastrostomy

Pancreatic surgeons try to find the best technique for reconstruction after pancreatoduodenectomy (PD) in order to decrease postoperative complications, mainly pancreatic fistulas (PF). In this work, we compare the two most frequent techniques of reconstruction after PD, pancreatojejunostomy (PJ) and pancreatogastrostomy (PG), in order to determine which of the two is better. A systematic review of the literature was performed, including major meta-analysis articles, clinical randomized trials, systematic reviews, and retrospective studies. A total of 64 articles were finally included. PJ and PG are usually responsible for most of the postoperative morbidity, mainly due to the onset of PF, being considered a major trigger of life-threatening complications such as intra-abdominal abscess and hemorrhagia. The included systematic reviews reported a significant difference only in the incidence of intraabdominal collections favouring PG. PF, delayed gastric emptying and mortality were not different. Although there was heterogeneity between these studies, all were conducted in specialized centers by highly experienced surgeons, and the surgical care was likely to be similar for all the studies. The disadvantages of PG include an increased incidence of delayed gastric emptying and of main pancreatic duct obstruction due to overgrowth by the gastric mucosa. Exocrine function appears to be worse after PG than after PJ, resulting in severe atrophic changes in the remnant pancreas. Depending on the type of PJ or PG used, the PF rate and other complications can also be different. The best method to deal with the pancreatic stump after PD remains questionable. The choice of method of pancreatic anastomosis could be based on individual experience and on the surgeon’s preference and adherence to basic principles such as good exposure and visualization. In conclusion, up to now none of the techniques can be considered superior or be recommended as standard for reconstruction after PD.     

残胰直接套入空肠吻合技术在胰十二指肠切除术中的临床应用研究

目的:总结和探讨胰十二指肠切除术后空肠非去黏膜化的胰- 肠直接套入吻合方法,并观察其术后发生胰瘘及对与该手术方式有关的并发症等资料进行分析。方法:2005年3 月至2009年6 月中山大学附属东华医院行胰十二指肠切除术21例,残胰游离3.0cm,距离残胰断端2.5～3.0cm行空肠全层与部分胰腺后壁组织间断缝合,将残胰套入空肠2.5～3.0cm,再按后壁缝合方法缝合前壁,在距离残胰断端1cm处用7 号丝线环绕空肠将残胰予以捆扎。结果:除1 例出现因残胰断端出血再次手术进行缝合止血外,全组患者术后恢复顺利,无1 例发生胰瘘或出现其他并发症。结论:胰腺质地和胰- 肠吻合方式虽是胰瘘并发症的主要因素,但也与手术者胰- 肠吻合操作技巧或熟练程度、围手术期的管理或治疗措施有关。采用残胰直接套入非去空肠黏膜化的胰- 肠吻合方法与目前任何其他胰-肠吻合方法比较均较为简单,有待于进一步探讨、总结和研究。      

Intraoperative conditions of patients undergoing pancreatoduodenectomy

BackgroundPostoperative pancreatic fistula (POPF) is a severe complication following pancreatoduodenectomy (PD). Previous research in colorectal surgery demonstrated suboptimal intraoperative conditions to be related with an increased risk of anastomotic leakage. Aim of this study was to evaluate the intraoperative condition of patients undergoing PD by both assessing whether these known intraoperative modifiable risk factors in colorectal surgery are also present during PD and by measuring compliance to intraoperative ERAS guidelines. Secondly, to determine the relation of these factors with POPF.Materials and methodsThis prospective single center study included patients undergoing PD from 2016 to 2020. Parameters regarding the patient's general condition, local perfusion, oxygenation, surgical factors and ERAS elements were measured with a checklist intraoperatively, before the creation of the pancreatojejunal anastomosis. Uni- and multivariable logistic regression analyses were performed.Results83 patients were included. POPF occurred in 27.7% (9.0% grade B, 10.0% grade C). Patients with POPF significantly had more other postoperative complications compared to patients without POPF (100% vs. 76.2%, p = 0.017). A suboptimal intraoperative condition was observed in 89.2%. Overall compliance to the intraoperative ERAS guideline was 0%. In univariable analysis, soft pancreatic tissue, pancreatic duct <3 mm, tumor location and intraoperative vasopressor administration were significantly associated with POPF. In multivariable analysis, only soft pancreatic tissue was independently associated with POPF (OR 13.627; 95% CI 1.656–112.157, p = 0.015).ConclusionAwareness amongst surgeons and anesthesiologists should be created. The influence of these intraoperative factors on POPF should be further evaluated in future, larger studies.     

Pankreaskarzinom – Operationsindikation und chirurgische Radikalität

Surgery of pancreatic cancer can nowadays be performed in a safe manner and with a continuous reduction of morbidity and mortality (<5%) in centers of excellence. The reduction of mortality by efficient management of complications and reduced incidence of complications by elaborate surgical techniques are contrasted by the inadequate oncologic results after surgery for pancreatic cancer. The safety of the procedures in skilled hands in recent years has led to a more aggressive surgical approach towards the disease. Resections of the portal vein and adjacent organs (multivisceral) are justified to achieve a R0 situation. Resections of arterial structures and extended lymphadenectomy do not withstand evidence-based evaluation and cannot therefore be recommended. Radical surgical therapy under these circumstances is the prerequisite for efficient adjuvant therapy and subsequent curative treatment options for pancreatic cancer.     

Central pancreatectomy for benign or low-grade malignant pancreatic lesions - A single-center retrospective analysis of 116 cases

BackgroundCentral pancreatectomy (CP) is a parenchyma-sparing surgery for benign or low-grade malignant pancreatic tumors. This study aimed to evaluate the safety of the procedure and to analyze the long-term pancreatic function. The age-specific incidence ratio (IR) was calculated based on the incidence of diabetes mellitus in the general Italian population of Italy.Materials and methodsPatients submitted to CP from January 1990 to December 2017 at the Department of General and Pancreatic Surgery of the Pancreas Institute of Verona, Italy, were evaluated.ResultsThe final population was composed of 116 patients. There was a clear prevalence of females (74.1%), the mean age was 48 ± 15 years and the main indication for surgery was a pancreatic neuroendocrine tumor (45.7%). A pancreojejunal anastomosis was performed more frequently than a pancreogastric anastomosis (78.4% vs 11.6%). The mean length of stay was 20 ± 33 days.The overall abdominal complications rate was 62%. The frequency of clinically relevant postoperative pancreatic fistula (grades B and C) was 26.7%. The mortality rate was 0%. The rate of R1-resection was 0.8%, as was the recurrence rate. After a mean follow-up of 12.8 years ±6.5, 6 patients developed new-onset diabetes (NODM, 7.5%), and the IR was 1.36 (95%CI 0.49–2.96).ConclusionsCP is associated with high rates of abdominal complications, however, considering the amount of the normal pancreas that was spared, it might be indicated for selected benign or low-malignancy pancreatic tumors. CP patients have the same incidence of diabetes than the general population.     

Robotic pancreaticoduodenectomy for pancreatic adenocarcinoma: role in 2014 and beyond

Minimally invasive surgery (MIS) for pancreatic adenocarcinoma has found new avenues for performing pancreaticoduodenectomy (PD) procedures, a historically technically challenging operation. Multiple studies have found laparoscopic PD to be safe, with equivalent oncologic outcomes as compared to open PD. In addition, several series have described potential benefits to minimally invasive PD including fewer postoperative complications, shorter hospital length of stay, and decreased postoperative pain. Yet, despite these promising initial results, laparoscopic PDs have not become widely adopted by the surgical community. In fact, the vast majority of pancreatic resections performed in the United States are still performed in an open fashion, and there are only a handful of surgeons who actually perform purely laparoscopic PDs. On the other hand, robotic assisted surgery offers many technical advantages over laparoscopic surgery including high-definition, 3-D optics, enhanced suturing ability, and more degrees of freedom of movement by means of fully-wristed instruments. Similar to laparoscopic PD, there are now several case series that have demonstrated the feasibility and safety of robotic PD with seemingly equivalent short-term oncologic outcomes as compared to open technique. In addition, having the surgeon seated for the procedure with padded arm-rests, there is an ergonomic advantage of robotics over both open and laparoscopic approaches, where one has to stand up for prolonged periods of time. Future technologic innovations will likely focus on enhanced robotic capabilities to improve ease of use in the operating room. Last but not least, robotic assisted surgery training will continue to be a part of surgical education curriculum ensuring the increased use of this technology by future generations of surgeons.     

200例胰十二指肠切除术后早期并发症危险因素分析(英文)

目的胰十二指肠切除术是目前许多壶腹周围良恶性疾病的首选治疗方式。本研究目的是寻找出胰十二指肠切除术后的早期并发症发生的危险因素。方法回顾分析1996年10月至2002年9月共200例胰十二指肠切除术的临床资料。其中包括标准胰十二指肠切除术176例,加做扩大腹膜后淋巴结廓清术者为24例,无保留幽门括约肌者。对于胰腺质地硬且胰管扩张患者采用端侧粘膜对粘膜胰肠吻合,而胰腺质软且胰管扩张不明显患者行对端套入胰腺空肠吻合。通过单因素及多因素方法分析早期并发症发生的相关因素。结果术后并发症发生率为21%(42/200),胰肠吻合口瘘最为常见。高龄(优势比2.162),术前合并糖尿病(优势比4.0862),术前血清总胆红素水平高于171.1μmol/L(优势比7.556),端端胰肠吻合(优势比2.616)以及术中输血量超过1000 mL(优势比2.410)是术后早期并发症发生的独立危险影响因素。而胆肠吻合口留置 T 管(优势比0.100)可以显著减少术后早期并发症的发生。结论已经发表的关于胰十二指肠切除术早期并发症危险因素的相关文献之间的可比性不强。对于不同的专业组及患者,胰十二指肠切除术应当个体化,以期获得最好的治疗效果。     

Pancreatoduodenectomy associated complications influence cancer recurrence and time interval to death

Background

Resection is the only life-prolonging option for pancreatic or periampullary cancer. Cell-mediated immunity might reduce progression of metastasis or local recurrence likelihood, but surgery associated morbidity can suppress this immunity. The aim of this study was to examine the influence of complications on cancer specific survival after pancreatoduodenectomy (PD) for pancreatic and periampullary cancer.

Method

517 consecutive patients who underwent PD for pancreatic or periampullary adenocarcinoma were analysed.

Results

After median follow-up of 24 (14–44) months, 377 (73%) patients had died from progressive disease, 140 (27%) were alive. Median survival for pancreatic adenocarcinoma was 22 (18–25) months following an uncomplicated postoperative course versus 16 (13–19) months for patients with major surgical complications (p = 0.021). Multivariable Cox regression analysis demonstrated that microscopically residual disease (R1), complications, and adjuvant therapy were independent factors for recurrence. Within the R1 group, survival for patients with complications was even more limited, 9.7 (8.3–11.0) versus 18.7 (15.0–22.5) for those without (p < 0.001). For patients with R1 resection complications was the only independent predictor for a shorter time interval to death (hazard ratio 1.96; 95% CI 1.16–3.30). Complications did not influence survival of patients with periampullary adenocarcinoma.

Conclusion

Complications after resection are independently related to an impaired survival following PD for pancreatic, but not periampullary cancer. The effect is even more dramatic in patients who had an R1 resection. Although the relation is not causal per se, the findings support the hypothesis of a complication-induced, compromised immunity rendering patients more susceptible for recurrent disease.     

Determinants of complications in pancreaticoduodenectomy.

AIMS: The factors determining complications after pancreaticoduodenectomy (PD) have not yet been identified clearly. This retrospective study examined, using reproducible classification systems, the type and severity of complications as well as the factors to predict them. METHODS: Between 1998 and 2005 PD was performed in 351 consecutive patients with peri-ampullary tumours. Logistic regression models were used in univariate as well as in corrected, multivariate analyses in order to identify the optimally combined factors related to the occurrence of post-operative complications. RESULTS: Post-operative complication rate was 50.7%, mortality 3.1% and re-operation rate 7.1%. Pancreatic fistula (12%) was responsible for higher mortality (9.5%; p=0.011) and re-operation (30.9%; p<0.001) rates. Hospital length of stay (LOS) was (p<0.001) longer for patients with post-operative complications (median 21.5 (range 1-128) vs. 14 (7-42) days) or pancreatic fistula (28.5 (8-128) vs. 17 (1-63) days), and related to the severity of complications. Surgeon (Odds ratio [OR] 2.03; confidence interval [CI] 1.20-3.41; p=0.008), male gender (OR 1.72; CI 1.05-2.81; p=0.032), and pre-operative hyperbilirubinaemia (OR 1.04; CI 1.001-1.08; p=0.046) were independent risk factors for post-operative complications. Neither prophylactic octreotide nor pre-operative biliary drainage improved post-operative outcome. CONCLUSION: Surgeon, male gender, and pre-operative hyperbilirubinaemia determine complication rate following PD. Pancreatic fistula is the most common complication and is associated with increased mortality, re-operation rate and LOS.