Clinical analysis of postoperative mortality and morbidity of pancreatic adenocarcinoma

Pancreatic adenocarcinoma is a highly lethal disease with a poor prognosis. This paper analyses the postoperative mortality and morbidity of 155 tissue-proven pancreatic adenocarcinoma presenting from January 1981 to December 1991 at Chang Gung Memorial Hospital. Locations of the pancreatic tumor were at the pancreatic head in 109 cases (70.3%), head with body or diffuse gland in 24 (15.5%), body or tail in 22 (14.2%). All patients were stratified by TNM staging (I, 13.6%; II, 8.4%; III, 34.8%; IV, 43.2%). There were 28 pancreatectomies (18.1%), 87 patients with biliary-enteric bypass or gastrojejunostomy (56.1%) and laparotomy with tumor biopsy only for another 40 patients (25.8%). Patients with pancreatectomy includes Whipple operation in 17, total pancreatectomy in 3, subtotal pancreatectomy in 3 and 5 distal pancreatectomies. Fourteen patients died during hospitalization after operation with a 9.0% mortality rate of pancreatic cancer surgery. The mortality of pancreatectomy, bypass, and laparotomy groups with pancreatic cancer were 7.1%; 5.7%; 17.5% respectively. Thirty-four patients (21.9%) had complications after surgery and there was a 50% complication rate in the pancreatectomy group, 16.1% in the bypass group and 15% in laparotomy patients. The complications of pancreatectomy were hyperglycemia in seven cases, pancreaticojejunal or choledochojejunal insufficiency in five, upper GI bleeding in five, wound infection in five, and intraoperative vascular injury in three patients. The most common complications of the non-pancreatectomy group were postoperative pancreatitis in seven, upper gastrointestinal bleeding in four, wound infection in four, hepatorenal syndrome in two, and another two patients with hemobilia. The risk factors of postoperative mortality of pancreatic cancer were age ≥ 70 years; serum albumin < 3.0 gm% and hemoglobulin < 12.0 gm% (p<0.05). Biliary tract infection was the most important factor of postoperative morbidity for pancreatic cancer surgery, but statistics are not significant (p = 0.054).