Interventional radiology in the management of complications after pancreatic surgery: a single-center experience.
Interventional radiology-first management linked to lower 90-day mortality in clinically relevant pancreatic fistula
Interventional radiology in the management of complications after pancreatic surgery: a single-center experience.
To assess the impact of interventional radiology (interventional radiology) as first-line rescue therapy for major complications after pancreaticoduodenectomy and to quantify its effect on surgical re-exploration and 90-day mortality.
Were grouped by initial management strategy (interventional radiology-first vs. primary surgery); crossover to the alternative treatment was recorded and interpreted within a step-up management framework rather than uniformly as treatment failure.
90-day mortality was lower with radiology-first than surgery-first treatment, unadjusted comparison
Overall, 126/200 patients (63%) developed postoperative complications and 75/126 (59.5%) required early re-intervention.
Interventional radiology accounted for 63/75 reinterventions (84.0%).
Postoperative pancreatic fistula occurred in 79/200 (39.5%); CR-postoperative pancreatic fistula in 49/200 (24.5%).
Biliary complications were managed primarily with interventional radiology in 32/33 patients (97.0%).
A substantial proportion of major post-pancreaticoduodenectomy complications can be controlled with minimally invasive interventional radiology techniques, limiting surgical re-exploration.
interventional radiology-first strategy was associated with lower 90-day mortality in unadjusted analysis; however, this association was attenuated after adjustment for clinical severity.
Prospective multicenter studies are needed to further refine selection criteria and step-up treatment algorithms. LEVEL OF EVIDENCE: Level 3, therapeutic study.