Common complications after pancreatic cancer surgery

Surgery is the most common method for treating pancreatic cancer and is also the treatment method with the best chance of achieving long-term survival. However, surgical treatment can also cause great damage to the patient's body and cause various types of complications, the most common of which are pancreatic fistula, postoperative bleeding, abdominal abscess, bile fistula and postoperative diabetes, etc. The specific manifestations are as follows:

1. Pancreatic fistula

If the drainage volume near the pancreaticojejunostomy is large, light in color, non-sticky, and the amylase content exceeds 1000U/ml, pancreatic fistula can be diagnosed. Only a few cases require angiography. Once pancreatic fistula is confirmed, it should be actively treated and adequately drained. If the drainage is not smooth, drainage expansion surgery should be performed in time.

Pancreatic fistula can cause intra-abdominal infection and intra-abdominal corrosive bleeding, which is very harmful and is one of the main causes of postoperative death.

2. Postoperative bleeding

The incidence of postoperative bleeding after pancreaticoduodenectomy is 5% to 7.5%. Careful operation and hemostasis (especially at the pancreatic stump) are the basic guarantees for preventing postoperative bleeding: good treatment of pancreatic fistula can avoid secondary bleeding; unobstructed drainage can prevent corrosive bleeding in the late stage of abdominal sepsis; strengthening support methods and routine use of cyanoguanidine drugs can help reduce the occurrence of stress ulcer bleeding. Postoperative bleeding caused by incomplete hemostasis often occurs within 24 hours after surgery.

3. Postoperative intra-abdominal abscess

Postoperative intra-abdominal abscess is caused by poor postoperative drainage, with an incidence of about 4% to 10%. It manifests as chills, high fever, abdominal distension, gastric motility disorders, and increased white blood cell count. If not treated in time, corrosive vascular bleeding and abdominal sepsis may often occur. B-ultrasound and CT scans are helpful in the diagnosis and location of this complication. Abscess puncture and catheter drainage can be performed under B-ultrasound guidance, and surgical drainage should be performed again if necessary.

4. Biliary fistula

The placement of a T-tube may help prevent bile fistula, but retaining a longer common bile duct for the placement of a T-tube will affect the radicality of the operation. Fortunately, the incidence of bile fistula has decreased and is easy to treat. As long as the external drainage is kept unobstructed, there is a great chance of spontaneous healing.

5. Postoperative diabetes

All patients who undergo total pancreatectomy will have residual diabetes after surgery, and about 8% of patients who undergo pancreaticoduodenectomy or distal pancreatectomy will have residual diabetes. Many surgical patients have latent diabetes, and elderly patients have poor islet function and are more likely to develop diabetes after pancreatic surgery. Therefore, blood sugar and urine sugar should be measured frequently after surgery to keep abreast of the patient's sugar metabolism.