Operative and Perioperative Management

Experience for Hepatobiliary Malignancies Following

ERCP – Related Pancreatitis

T. Tsuchikawa et al,www.hepatogastroenterology.org DOI

10.5754/hge 121344 2013: 60 (128)
Oleh :
Agung Bahtiar
I11105043
Introduction
• Hepatobiliary malignancies continue to have a
poor prognosis
• Surgical resection is a curative option for the
treatment of these diseases
• Therefore, preoperative dignostic evaluations
in terms of the diseas extent are quite
important
BACKGROUND
• how to treat hepatobiliary malignancies after
ERCP – related pancreatitis focusing on the
timing of the operation and postoperative
complications.
• The aim of this study was to clarify the
relationship among the time after the
pancreatitis,the complexity of the operation, and
the characteristic postoperative complications
• METHOD
Patients
• A total of 81 patients with hepatobiliary
malignancies underwent radical surgery
• Of these, five patient had a prior history of
ERCP- related pancreatitis and were analyzed.
Assesment
• The severity of pancreatitis was classified
according to the imrine score.
• For the Imrine severity criteria :
 Patients were scored by age (> 55 years)
WBC count ( 1x 100.000/ uL)
Blood glucose ( > 10 mmol/L )
Blood urea (16 mmol/L)
Arterial oxygen partial pressure ( < 8.0 kPa )
 Serum albumin ( < 32 g/L)
Serum calcium ( < 2.9 mmol/L)
Lactate dehydrogenase (600 U/L)
• RESULTS :
Patient characteristic
• The ages of the five patients,four male and
one female, ranged from 61 to 82 years with a
median of 70 years .
• There were two extrahepatic bile duct
carcinomas , two ampulla of vater carcinomas,
and one intrahepatic cholangiocarcinoma
Perioperative results

• The median period to operation from

pancreatitis was 31 (16-116) days.
• The median operation time and blood loss
were 661 (579-924) min and 3695 (2730-
7240) ml
• Various postoperative complications were
seen in all cases including acute respiratory
distress syndrome and infection of
peripancreatic necrosis.
• The postoperative mortality rate was 0%, with
a morbidity rate of 100%.
• Operations were performed in all five cases
Discussion
• Post- ERCP acute pancreatitis is major
complication that develops in about 1,5 % to
17 % of all ERCP cases.
• Once pancreatitis occurs, the operation
becomes extremely difficult, resulting in a
longer operation time, much blood loss, and a
high rate of postoperative complications.
• In the present series of patients, several
characteristic findings related to operation
timing and postoperative complications were
identified.
– Firstly, severe ERCP-related pancreatitis is frequently
associated with pancreatic and peripancreatic fluid
collections or necrosis
– Secondly, in terms of inflammatory changes after
pancreatitis, atherosclerotic change of the peri-
pancreatic lesion might be continuing in the acute to
subacute periods
– Lastly, in terms of the inflammation and infection,
although inflammation from pancreatitis had resolved
clinically at the time of the operation without fever or
abdominal pain, potent smoldering inflammation
could have been continuing
Conclusion
• Surgery for hepatobiliary malignancies after
ERCP pancreatitis could have a high morbidity
rate.
• The surgery must strike a balance between
curability for the malignancy and safety with
respect to the frequent postoperative
complications
THANKS YOU