Late acute pancreatitis after pancreaticoduodenectomy: incidence, outcome, and risk factors

摘要

Abstract Background The pancreatoenteric anastomotic stricture (PEAS) is a common long‐term complication after pancreaticoduodenectomy (PD), some of which present as acute pancreatitis requiring emergency care. This important topic has never been reported. In this study, we focus on the incidence, radiological features, clinical outcome, and risk factors of late‐occurring acute pancreatitis (LAP) after PD. Methods We retrospectively reviewed a prospectively collected database of 539 patients who underwent PD at a single tertiary referral center between June 2005 and December 2014. Only patients with at least 3?years of follow‐up and available pre‐ and post‐operative images were included. Results Of the 539 patients, 23 (15 [65%] with and eight [35%] without PEAS) were diagnosed with LAP after PD. The cumulative incidence of LAP was 3.6% (1‐year), 4.4% (2‐year), and 5.1% (5‐year). The median time to the first LAP episode was 22?months (range 8–38?months) after PD. All the first and recurrent LAP events were mild in severity and resolved after conservative treatment. Multivariate analysis showed that a history of acute pancreatitis before PD ( P? = ? 0.001, HR?5.24, 95% CI?1.95–14.10) and PEAS ( P? = ? 0.047, HR?2.75, 95% CI?1.01–7.49) were two significant risk factors. Conclusions We propose using a more conservative treatment for patients who experience LAP after PD.