Pancreaticoduodenectomy in trauma patients with grade IV-V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial

Rachel Leah Choron; Charoo Piplani; Julia Kuzinar; Amanda L. Teichman; Christopher Bargoud; Jason D. Sciarretta; Randi N. Smith; Dustin Hanos; Iman N. Afif; Jessica H. Beard; Navpreet Kaur Dhillon; Ashling Zhang; Mira Ghneim; Rebekah Devasahayam; Oliver Gunter; Alison A. Smith; Brandi Sun; Chloe S. Cao; Jessica K. Reynolds; Lauren A. Hilt; Daniel N. Holena; Grace Chang; Meghan Jonikas; Karla Echeverria-Rosario; Nathaniel S. Fung; Aaron Anderson; Caitlin A. Fitzgerald; Ryan Peter Dumas; Jeremy H. Levin; Christine T. Trankiem; Jae Hee Yoon; Jacqueline Blank; Joshua P. Hazelton; Christopher J. Mclaughlin; Rami Al-Aref; Jordan Michael Kirsch; Daniel S. Howard; Dane R. Scantling; Kate Dellonte; Michael A. Vella; Brent Hopkins; Chloe Shell; Pascal Udekwu; Evan G. Wong; Bellal Joseph; Howard Lieberman; Walter A. Ramsey; Collin H. Stewart; Claudia Alvarez; John D. Berne; Jeffry Nahmias; Ivan Puente; Joe Patton; Ilya Rakitin; Lindsey Perea; Odessa Pulido; Hashim Ahmed; Jane Keating; Lisa M. Kodadek; Jason Wade; Henry Reynold; Martin Schreiber; Andrew Benjamin; Abid Khan; Laura K. Mann; Caleb Mentzer; Vasileios Mousafeiris; Francesk Mulita; Shari Reid-Gruner; Erica Sais; Christopher W. Foote; Carlos H. Palacio; Dias Argandykov; Haytham Kaafarani; Michelle T.Bover Manderski; Lilamarie Moko; Mayur Narayan; Mark Seamon

doi:10.1136/tsaco-2024-001438

Pancreaticoduodenectomy in trauma patients with grade IV-V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial

Rachel Leah Choron, Charoo Piplani, Julia Kuzinar, Amanda L. Teichman, Christopher Bargoud, Jason D. Sciarretta, Randi N. Smith, Dustin Hanos, Iman N. Afif, Jessica H. Beard, Navpreet Kaur Dhillon, Ashling Zhang, Mira Ghneim, Rebekah Devasahayam, Oliver Gunter, Alison A. Smith, Brandi Sun, Chloe S. Cao, Jessica K. Reynolds, Lauren A. HiltDaniel N. Holena, Grace Chang, Meghan Jonikas, Karla Echeverria-Rosario, Nathaniel S. Fung, Aaron Anderson, Caitlin A. Fitzgerald, Ryan Peter Dumas, Jeremy H. Levin, Christine T. Trankiem, Jae Hee Yoon, Jacqueline Blank, Joshua P. Hazelton, Christopher J. Mclaughlin, Rami Al-Aref, Jordan Michael Kirsch, Daniel S. Howard, Dane R. Scantling, Kate Dellonte, Michael A. Vella, Brent Hopkins, Chloe Shell, Pascal Udekwu, Evan G. Wong, Bellal Joseph, Howard Lieberman, Walter A. Ramsey, Collin H. Stewart, Claudia Alvarez, John D. Berne, Jeffry Nahmias, Ivan Puente, Joe Patton, Ilya Rakitin, Lindsey Perea, Odessa Pulido, Hashim Ahmed, Jane Keating, Lisa M. Kodadek, Jason Wade, Henry Reynold, Martin Schreiber, Andrew Benjamin, Abid Khan, Laura K. Mann, Caleb Mentzer, Vasileios Mousafeiris, Francesk Mulita, Shari Reid-Gruner, Erica Sais, Christopher W. Foote, Carlos H. Palacio, Dias Argandykov, Haytham Kaafarani, Michelle T.Bover Manderski, Lilamarie Moko, Mayur Narayan, Mark Seamon

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Introduction The utility of pancreaticoduodenectomy (PD) for high-grade traumatic injuries remains unclear and data surrounding its use are limited. We hypothesized that PD does not result in improved outcomes when compared with non-PD surgical management of grade IV-V pancreaticoduodenal injuries. Methods This is a retrospective, multicenter analysis from 35 level 1 trauma centers from January 2010 to December 2020. Included patients were ≥15 years of age with the American Association for the Surgery of Trauma grade IV-V duodenal and/or pancreatic injuries. The study compared operative repair strategy: PD versus non-PD. Results The sample (n=95) was young (26 years), male (82%), with predominantly penetrating injuries (76%). There was no difference in demographics, hemodynamics, or blood product requirement on presentation between PD (n=32) vs non-PD (n=63). Anatomically, PD patients had more grade V duodenal, grade V pancreatic, ampullary, and pancreatic ductal injuries compared with non-PD patients (all p<0.05). 43% of all grade V duodenal injuries and 40% of all grade V pancreatic injuries were still managed with non-PD. One-third of non-PD duodenal injuries were managed with primary repair alone. PD patients had more gastrointestinal (GI)-related complications, longer intensive care unit length of stay (LOS), and longer hospital LOS compared with non-PD (all p<0.05). There was no difference in mortality or readmission. Multivariable logistic regression analysis determined PD to be associated with a 3.8-fold greater odds of GI complication (p=0.010) compared with non-PD. In a subanalysis of patients without ampullary injuries (n=60), PD patients had more anastomotic leaks compared with the non-PD group (3 (30%) vs 2 (4%), p=0.028). Conclusion While PD patients did not have worse hemodynamics or blood product requirements on admission, they sustained more complex anatomic injuries and had more GI complications and longer LOS than non-PD patients. We suggest that the role of PD should be limited to cases of massive destruction of the pancreatic head and ampullary complex, given the likely procedure-related morbidity and adverse outcomes when compared with non-PD management. Level of evidence IV, Multicenter retrospective comparative study.

Original language	English (US)
Article number	e001438
Journal	Trauma Surgery and Acute Care Open
Volume	9
Issue number	1
DOIs	https://doi.org/10.1136/tsaco-2024-001438
State	Published - Dec 20 2024

Keywords

abdominal injuries
duodenum
multiple trauma
pancreas

ASJC Scopus subject areas

Surgery
Critical Care and Intensive Care Medicine

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10.1136/tsaco-2024-001438

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Choron, R. L., Piplani, C., Kuzinar, J., Teichman, A. L., Bargoud, C., Sciarretta, J. D., Smith, R. N., Hanos, D., Afif, I. N., Beard, J. H., Dhillon, N. K., Zhang, A., Ghneim, M., Devasahayam, R., Gunter, O., Smith, A. A., Sun, B., Cao, C. S., Reynolds, J. K., ... Seamon, M. (2024). Pancreaticoduodenectomy in trauma patients with grade IV-V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial. Trauma Surgery and Acute Care Open, 9(1), Article e001438. https://doi.org/10.1136/tsaco-2024-001438

Choron, RL, Piplani, C, Kuzinar, J, Teichman, AL, Bargoud, C, Sciarretta, JD, Smith, RN, Hanos, D, Afif, IN, Beard, JH, Dhillon, NK, Zhang, A, Ghneim, M, Devasahayam, R, Gunter, O, Smith, AA, Sun, B, Cao, CS, Reynolds, JK, Hilt, LA, Holena, DN, Chang, G, Jonikas, M, Echeverria-Rosario, K, Fung, NS, Anderson, A, Fitzgerald, CA, Dumas, RP, Levin, JH, Trankiem, CT, Yoon, JH, Blank, J, Hazelton, JP, Mclaughlin, CJ, Al-Aref, R, Kirsch, JM, Howard, DS, Scantling, DR, Dellonte, K, Vella, MA, Hopkins, B, Shell, C, Udekwu, P, Wong, EG, Joseph, B, Lieberman, H, Ramsey, WA, Stewart, CH, Alvarez, C, Berne, JD, Nahmias, J, Puente, I, Patton, J, Rakitin, I, Perea, L, Pulido, O, Ahmed, H, Keating, J, Kodadek, LM, Wade, J, Reynold, H, Schreiber, M, Benjamin, A, Khan, A, Mann, LK, Mentzer, C, Mousafeiris, V, Mulita, F, Reid-Gruner, S, Sais, E, Foote, CW, Palacio, CH, Argandykov, D, Kaafarani, H, Manderski, MTB, Moko, L, Narayan, M & Seamon, M 2024, 'Pancreaticoduodenectomy in trauma patients with grade IV-V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial', Trauma Surgery and Acute Care Open, vol. 9, no. 1, e001438. https://doi.org/10.1136/tsaco-2024-001438

@article{487594a096cb456daed561e7c464397f,

title = "Pancreaticoduodenectomy in trauma patients with grade IV-V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial",

abstract = "Introduction The utility of pancreaticoduodenectomy (PD) for high-grade traumatic injuries remains unclear and data surrounding its use are limited. We hypothesized that PD does not result in improved outcomes when compared with non-PD surgical management of grade IV-V pancreaticoduodenal injuries. Methods This is a retrospective, multicenter analysis from 35 level 1 trauma centers from January 2010 to December 2020. Included patients were ≥15 years of age with the American Association for the Surgery of Trauma grade IV-V duodenal and/or pancreatic injuries. The study compared operative repair strategy: PD versus non-PD. Results The sample (n=95) was young (26 years), male (82%), with predominantly penetrating injuries (76%). There was no difference in demographics, hemodynamics, or blood product requirement on presentation between PD (n=32) vs non-PD (n=63). Anatomically, PD patients had more grade V duodenal, grade V pancreatic, ampullary, and pancreatic ductal injuries compared with non-PD patients (all p<0.05). 43% of all grade V duodenal injuries and 40% of all grade V pancreatic injuries were still managed with non-PD. One-third of non-PD duodenal injuries were managed with primary repair alone. PD patients had more gastrointestinal (GI)-related complications, longer intensive care unit length of stay (LOS), and longer hospital LOS compared with non-PD (all p<0.05). There was no difference in mortality or readmission. Multivariable logistic regression analysis determined PD to be associated with a 3.8-fold greater odds of GI complication (p=0.010) compared with non-PD. In a subanalysis of patients without ampullary injuries (n=60), PD patients had more anastomotic leaks compared with the non-PD group (3 (30%) vs 2 (4%), p=0.028). Conclusion While PD patients did not have worse hemodynamics or blood product requirements on admission, they sustained more complex anatomic injuries and had more GI complications and longer LOS than non-PD patients. We suggest that the role of PD should be limited to cases of massive destruction of the pancreatic head and ampullary complex, given the likely procedure-related morbidity and adverse outcomes when compared with non-PD management. Level of evidence IV, Multicenter retrospective comparative study.",

keywords = "abdominal injuries, duodenum, multiple trauma, pancreas",

author = "Choron, {Rachel Leah} and Charoo Piplani and Julia Kuzinar and Teichman, {Amanda L.} and Christopher Bargoud and Sciarretta, {Jason D.} and Smith, {Randi N.} and Dustin Hanos and Afif, {Iman N.} and Beard, {Jessica H.} and Dhillon, {Navpreet Kaur} and Ashling Zhang and Mira Ghneim and Rebekah Devasahayam and Oliver Gunter and Smith, {Alison A.} and Brandi Sun and Cao, {Chloe S.} and Reynolds, {Jessica K.} and Hilt, {Lauren A.} and Holena, {Daniel N.} and Grace Chang and Meghan Jonikas and Karla Echeverria-Rosario and Fung, {Nathaniel S.} and Aaron Anderson and Fitzgerald, {Caitlin A.} and Dumas, {Ryan Peter} and Levin, {Jeremy H.} and Trankiem, {Christine T.} and Yoon, {Jae Hee} and Jacqueline Blank and Hazelton, {Joshua P.} and Mclaughlin, {Christopher J.} and Rami Al-Aref and Kirsch, {Jordan Michael} and Howard, {Daniel S.} and Scantling, {Dane R.} and Kate Dellonte and Vella, {Michael A.} and Brent Hopkins and Chloe Shell and Pascal Udekwu and Wong, {Evan G.} and Bellal Joseph and Howard Lieberman and Ramsey, {Walter A.} and Stewart, {Collin H.} and Claudia Alvarez and Berne, {John D.} and Jeffry Nahmias and Ivan Puente and Joe Patton and Ilya Rakitin and Lindsey Perea and Odessa Pulido and Hashim Ahmed and Jane Keating and Kodadek, {Lisa M.} and Jason Wade and Henry Reynold and Martin Schreiber and Andrew Benjamin and Abid Khan and Mann, {Laura K.} and Caleb Mentzer and Vasileios Mousafeiris and Francesk Mulita and Shari Reid-Gruner and Erica Sais and Foote, {Christopher W.} and Palacio, {Carlos H.} and Dias Argandykov and Haytham Kaafarani and Manderski, {Michelle T.Bover} and Lilamarie Moko and Mayur Narayan and Mark Seamon",

note = "Publisher Copyright: {\textcopyright} 2024 Author(s) (or their employer(s)).",

year = "2024",

month = dec,

day = "20",

doi = "10.1136/tsaco-2024-001438",

language = "English (US)",

volume = "9",

journal = "Trauma Surgery and Acute Care Open",

issn = "2397-5776",

publisher = "BMJ Publishing Group",

number = "1",

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TY - JOUR

T1 - Pancreaticoduodenectomy in trauma patients with grade IV-V duodenal or pancreatic injuries

T2 - a post hoc analysis of an EAST multicenter trial

AU - Choron, Rachel Leah

AU - Piplani, Charoo

AU - Kuzinar, Julia

AU - Teichman, Amanda L.

AU - Bargoud, Christopher

AU - Sciarretta, Jason D.

AU - Smith, Randi N.

AU - Hanos, Dustin

AU - Afif, Iman N.

AU - Beard, Jessica H.

AU - Dhillon, Navpreet Kaur

AU - Zhang, Ashling

AU - Ghneim, Mira

AU - Devasahayam, Rebekah

AU - Gunter, Oliver

AU - Smith, Alison A.

AU - Sun, Brandi

AU - Cao, Chloe S.

AU - Reynolds, Jessica K.

AU - Hilt, Lauren A.

AU - Holena, Daniel N.

AU - Chang, Grace

AU - Jonikas, Meghan

AU - Echeverria-Rosario, Karla

AU - Fung, Nathaniel S.

AU - Anderson, Aaron

AU - Fitzgerald, Caitlin A.

AU - Dumas, Ryan Peter

AU - Levin, Jeremy H.

AU - Trankiem, Christine T.

AU - Yoon, Jae Hee

AU - Blank, Jacqueline

AU - Hazelton, Joshua P.

AU - Mclaughlin, Christopher J.

AU - Al-Aref, Rami

AU - Kirsch, Jordan Michael

AU - Howard, Daniel S.

AU - Scantling, Dane R.

AU - Dellonte, Kate

AU - Vella, Michael A.

AU - Hopkins, Brent

AU - Shell, Chloe

AU - Udekwu, Pascal

AU - Wong, Evan G.

AU - Joseph, Bellal

AU - Lieberman, Howard

AU - Ramsey, Walter A.

AU - Stewart, Collin H.

AU - Alvarez, Claudia

AU - Berne, John D.

AU - Nahmias, Jeffry

AU - Puente, Ivan

AU - Patton, Joe

AU - Rakitin, Ilya

AU - Perea, Lindsey

AU - Pulido, Odessa

AU - Ahmed, Hashim

AU - Keating, Jane

AU - Kodadek, Lisa M.

AU - Wade, Jason

AU - Reynold, Henry

AU - Schreiber, Martin

AU - Benjamin, Andrew

AU - Khan, Abid

AU - Mann, Laura K.

AU - Mentzer, Caleb

AU - Mousafeiris, Vasileios

AU - Mulita, Francesk

AU - Reid-Gruner, Shari

AU - Sais, Erica

AU - Foote, Christopher W.

AU - Palacio, Carlos H.

AU - Argandykov, Dias

AU - Kaafarani, Haytham

AU - Manderski, Michelle T.Bover

AU - Moko, Lilamarie

AU - Narayan, Mayur

AU - Seamon, Mark

PY - 2024/12/20

Y1 - 2024/12/20

N2 - Introduction The utility of pancreaticoduodenectomy (PD) for high-grade traumatic injuries remains unclear and data surrounding its use are limited. We hypothesized that PD does not result in improved outcomes when compared with non-PD surgical management of grade IV-V pancreaticoduodenal injuries. Methods This is a retrospective, multicenter analysis from 35 level 1 trauma centers from January 2010 to December 2020. Included patients were ≥15 years of age with the American Association for the Surgery of Trauma grade IV-V duodenal and/or pancreatic injuries. The study compared operative repair strategy: PD versus non-PD. Results The sample (n=95) was young (26 years), male (82%), with predominantly penetrating injuries (76%). There was no difference in demographics, hemodynamics, or blood product requirement on presentation between PD (n=32) vs non-PD (n=63). Anatomically, PD patients had more grade V duodenal, grade V pancreatic, ampullary, and pancreatic ductal injuries compared with non-PD patients (all p<0.05). 43% of all grade V duodenal injuries and 40% of all grade V pancreatic injuries were still managed with non-PD. One-third of non-PD duodenal injuries were managed with primary repair alone. PD patients had more gastrointestinal (GI)-related complications, longer intensive care unit length of stay (LOS), and longer hospital LOS compared with non-PD (all p<0.05). There was no difference in mortality or readmission. Multivariable logistic regression analysis determined PD to be associated with a 3.8-fold greater odds of GI complication (p=0.010) compared with non-PD. In a subanalysis of patients without ampullary injuries (n=60), PD patients had more anastomotic leaks compared with the non-PD group (3 (30%) vs 2 (4%), p=0.028). Conclusion While PD patients did not have worse hemodynamics or blood product requirements on admission, they sustained more complex anatomic injuries and had more GI complications and longer LOS than non-PD patients. We suggest that the role of PD should be limited to cases of massive destruction of the pancreatic head and ampullary complex, given the likely procedure-related morbidity and adverse outcomes when compared with non-PD management. Level of evidence IV, Multicenter retrospective comparative study.

AB - Introduction The utility of pancreaticoduodenectomy (PD) for high-grade traumatic injuries remains unclear and data surrounding its use are limited. We hypothesized that PD does not result in improved outcomes when compared with non-PD surgical management of grade IV-V pancreaticoduodenal injuries. Methods This is a retrospective, multicenter analysis from 35 level 1 trauma centers from January 2010 to December 2020. Included patients were ≥15 years of age with the American Association for the Surgery of Trauma grade IV-V duodenal and/or pancreatic injuries. The study compared operative repair strategy: PD versus non-PD. Results The sample (n=95) was young (26 years), male (82%), with predominantly penetrating injuries (76%). There was no difference in demographics, hemodynamics, or blood product requirement on presentation between PD (n=32) vs non-PD (n=63). Anatomically, PD patients had more grade V duodenal, grade V pancreatic, ampullary, and pancreatic ductal injuries compared with non-PD patients (all p<0.05). 43% of all grade V duodenal injuries and 40% of all grade V pancreatic injuries were still managed with non-PD. One-third of non-PD duodenal injuries were managed with primary repair alone. PD patients had more gastrointestinal (GI)-related complications, longer intensive care unit length of stay (LOS), and longer hospital LOS compared with non-PD (all p<0.05). There was no difference in mortality or readmission. Multivariable logistic regression analysis determined PD to be associated with a 3.8-fold greater odds of GI complication (p=0.010) compared with non-PD. In a subanalysis of patients without ampullary injuries (n=60), PD patients had more anastomotic leaks compared with the non-PD group (3 (30%) vs 2 (4%), p=0.028). Conclusion While PD patients did not have worse hemodynamics or blood product requirements on admission, they sustained more complex anatomic injuries and had more GI complications and longer LOS than non-PD patients. We suggest that the role of PD should be limited to cases of massive destruction of the pancreatic head and ampullary complex, given the likely procedure-related morbidity and adverse outcomes when compared with non-PD management. Level of evidence IV, Multicenter retrospective comparative study.

KW - abdominal injuries

KW - duodenum

KW - multiple trauma

KW - pancreas

UR - http://www.scopus.com/inward/record.url?scp=85214443898&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85214443898&partnerID=8YFLogxK

U2 - 10.1136/tsaco-2024-001438

DO - 10.1136/tsaco-2024-001438

M3 - Article

AN - SCOPUS:85214443898

SN - 2397-5776

VL - 9

JO - Trauma Surgery and Acute Care Open

JF - Trauma Surgery and Acute Care Open

IS - 1

M1 - e001438

ER -

Pancreaticoduodenectomy in trauma patients with grade IV-V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial

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