Severe postoperative pancreatitis following treatment of peritoneal metastases

Postoperative pancreatitis is an unusual complication of upper abdominal surgery that can result in severe morbidity and has been associated with postoperative death. It can be caused by trauma to the surface of the gland, injury to pancreatic ducts, vascular compromise, ductal obstruction within the pancreas parenchyma or because of duodenal stagnation. Our database of peritoneal surface malignancy patients was surveyed in a search for patients who manifested signs and symptoms of severe postoperative pancreatitis. Patients who were confirmed by a chart review to have postoperative pancreatitis are included in this study. The clinical and histologic features of these patients and the effects of pancreatitis on outcome were itemized. From a database of 1200 patients who were treated with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) and/or early postoperative intraperitoneal chemotherapy (EPIC), 12 patients (1.0 %) were confirmed to have severe postoperative pancreatitis. A lesser sac peritonectomy procedure was performed in 10 of the 12 patients (83.3 %). Eight of the 12 patients (66.6 %) required a return to the operating room. Seven of the 12 patients (58.3 %) manifested anastomotic leakage. A total gastrectomy was required in 58 patients with 6 patients (10.3 %) developing pancreatitis. The median length of hospital stay was 62 days. Two patients (16.6 %) died postoperatively. The clinical features and outcome of 12 patients who developed severe postoperative pancreatitis after CRS and HIPEC are presented. These data may assist in the postoperative management of patients having a major CRS. An early diagnosis requires a high index of suspicion.