Afferent limb syndrome and delayed GI problems after pancreaticoduodenectomy for pancreatic cancer: single-center, 14-year experience

作者：Pannala Rahul; Brandabur John J; Gan Seng Ian; Gluck Michael; Irani Shayan; Patterson David J; Ross Andrew S; Dorer Russell; Traverso L William; Picozzi Vincent J; Kozarek Richard A^*

来源：Gastrointestinal Endoscopy, 2011, 74(2): 295-302.

DOI：10.1016/j.gie.2011.04.029

Background: There are limited data on the incidence of afferent limb syndrome and other delayed GI problems in pancreatic cancer (PaC) patients, especially among long-term survivors (>2 years).
Objective: To evaluate the incidence of afferent limb syndrome (chronic afferent limb obstruction resulting in pancreatobiliary obstruction) and delayed GI problems in PaC patients after pancreaticoduodenectomy (PD).
Design: Retrospective case series.
Setting: Tertiary referral center.
Patients: PaC patients treated with PD (N = 186) over a 14-year period (January 1995-October 2009).
Interventions: Endoscopic balloon dilation and stent placement, percutaneous biliary drainage.
Main Outcome Measurements: Incidence of afferent limb syndrome and delayed GI complications (marginal ulcers, radiation enteropathy, anastomotic strictures).
Results: Mean age was 63 +/- 10 years; 55% of patients were male. Afferent limb syndrome was noted in 24 patients (13%). Median time to diagnosis was 1.2 years (range 0.03-12.3 years); obstruction was primarily caused by recurrent PaC (8 patients, 33%) and radiation enteropathy (9 patients, 38%). Afferent limb syndrome was more likely to develop in patients with 2 years or longer of follow-up (n = 71, [38%]) compared with patients with 2 years or less of follow-up, after controlling for age, sex, surgery type, and adjuvant treatment (adjusted odds ratio, 4.5; 95% CI, 1.8-11.7). Other delayed GI problems included radiation enteropathy (6%), marginal ulcers (5%), anastomotic strictures (4%), cholangitis/liver abscesses (5%), and GI bleeding (6%).
Limitations: Retrospective, single-center study.
Conclusions: GI problems, including afferent limb syndrome, are relatively common in PaC patients after surgery and adjuvant therapy. Clinicians should recognize and effectively treat these delayed GI problems, especially in long-term survivors. (Gastrointest Endosc 2011;74:295-302.)

• 出版日期2011-8