Clinical characteristics and long-term outcomes following pancreatic injury – An international multicenter cohort study
Laura L. Meijer,
Yrjö Vaalavuo,
Sara Regnér,
Ville Sallinen,
Aurora Lemma,
Urban Arnelo,
Roberto Valente,
Sofia Westermark,
David An,
John A.G. Moir,
Ellen A. Irwin,
Esther A. Biesel,
Ulrich T. Hopt,
Stefan Fichtner-Feigl,
Uwe A. Wittel,
Maximilian Weniger,
Henning Karle,
Frank W. Bloemers,
Robert Sutton,
Richard M. Charnley,
Dietrich A. Ruess,
Peter Szatmary
Affiliations
Laura L. Meijer
Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
Yrjö Vaalavuo
Department of Gastroenterology and Alimentary Tract Surgery, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
Sara Regnér
Department of Surgery, Institution of Clinical Sciences Malmö, Skåne University Hospital, Lund University, Lund, Sweden
Ville Sallinen
Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Finland; Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Finland
Aurora Lemma
Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Finland
Urban Arnelo
Department of Upper Gastrointestinal Diseases, Karolinska University Hospital and CLINTEC, Karolinska Institutet, Stockholm, Sweden and Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden
Roberto Valente
Department of Upper Gastrointestinal Diseases, Karolinska University Hospital and CLINTEC, Karolinska Institutet, Stockholm, Sweden and Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden
Sofia Westermark
Department of Surgical and Perioperative Sciences, Department of Surgery, Örnsköldsvik, Umeå University, Umeå, Sweden
David An
Department of Surgery, Linköping University and Department of Surgery, Vasterviks Sjukhus, Vastervik, Sweden
John A.G. Moir
Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
Ellen A. Irwin
Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
Esther A. Biesel
Center of Surgery, Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
Ulrich T. Hopt
Center of Surgery, Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
Stefan Fichtner-Feigl
Center of Surgery, Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
Uwe A. Wittel
Center of Surgery, Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
Maximilian Weniger
Department of General, Visceral and Transplantation Surgery, Ludwig-Maximilians-University, Munich, Germany
Henning Karle
Department of General, Visceral and Transplantation Surgery, Ludwig-Maximilians-University, Munich, Germany
Frank W. Bloemers
Department of Trauma Surgery, Amsterdam UMC, Univ(ersity) of Amsterdam, Amsterdam, The Netherlands
Robert Sutton
Department of Pancreatic Surgery, Liverpool University Hospitals NHS Foundation Trust and Department of Clinical and Molecular Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
Richard M. Charnley
Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
Dietrich A. Ruess
Center of Surgery, Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; Corresponding author.
Peter Szatmary
Department of Pancreatic Surgery, Liverpool University Hospitals NHS Foundation Trust and Department of Clinical and Molecular Cancer Medicine, University of Liverpool, Liverpool, United Kingdom; Corresponding author.
Background: Trauma to the pancreas is rare but associated with significant morbidity. Currently available management guidelines are based on low-quality evidence and data on long-term outcomes is lacking. This study aimed to evaluate clinical characteristics and patient-reported long-term outcomes for pancreatic injury. Methods: A retrospective cohort study evaluating treatment for pancreatic injury in 11 centers across 5 European nations over >10 years was performed. Data relating to pancreatic injury and treatment were collected from hospital records. Patients reported quality of life (QoL), changes to employment and new or ongoing therapy due to index injury. Results: In all, 165 patients were included. The majority were male (70.9%), median age was 27 years (range: 6–93) and mechanism of injury predominantly blunt (87.9%). A quarter of cases were treated conservatively; higher injury severity score (ISS) and American Association for the Surgery of Trauma (AAST) pancreatic injury scores increased the likelihood for surgical, endoscopic and/or radiologic intervention. Isolated, blunt pancreatic injury was associated with younger age and pancreatic duct involvement; this cohort appeared to benefit from non-operative management. In the long term (median follow-up 93; range 8–214 months), exocrine and endocrine pancreatic insufficiency were reported by 9.3% of respondents. Long-term analgesic use also affected 9.3% of respondents, with many reported quality of life problems (QoL) potentially attributable to side-effects of opiate therapy. Overall, impaired QoL correlated with higher ISS scores, surgical therapy and opioid analgesia on discharge. Conclusions: Pancreatic trauma is rare but can lead to substantial short- and long-term morbidity. Near complete recovery of QoL indicators and pancreatic function can occur despite significant injury, especially in isolated, blunt pancreatic injury managed conservatively and when early weaning off opiate analgesia is achieved.
