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

Rachel Leah Choron¹, Charoo Piplani², Julia Kuzinar¹, Amanda L Teichman¹, Christopher Bargoud^{2

3}, Jason D Sciarretta⁴, Randi N Smith⁵, Dustin Hanos⁶, Iman N Afif⁷, Jessica H Beard⁸, Navpreet Kaur Dhillon⁹, Ashling Zhang¹⁰, Mira Ghneim⁹, Rebekah Devasahayam¹¹, Oliver Gunter¹², Alison A Smith¹³, Brandi Sun¹³, Chloe S Cao¹⁴, Jessica K Reynolds¹⁴, Lauren A Hilt¹⁵, Daniel N Holena¹⁵, Grace Chang¹⁶, Meghan Jonikas¹⁷, Karla Echeverria-Rosario¹⁸, Nathaniel S Fung¹⁹, Aaron Anderson²⁰, Caitlin A Fitzgerald²¹, Ryan Peter Dumas²², Jeremy H Levin²⁰, Christine T Trankiem²³, JaeHee Yoon²³, Jacqueline Blank²⁴, Joshua P Hazelton²⁵, Christopher J McLaughlin²⁶, Rami Al-Aref²⁷, Jordan Michael Kirsch²⁷, Daniel S Howard²⁸, Dane R Scantling²⁸, Kate Dellonte²⁹, Michael A Vella³⁰, Brent Hopkins³¹, Chloe Shell³², Pascal Udekwu³³, Evan G Wong³¹, Bellal Joseph³⁴, Howard Lieberman³⁵, Walter A Ramsey³⁵, Collin H Stewart³⁴, Claudia Alvarez³⁶, John D Berne³⁷, Jeffry Nahmias³⁶, Ivan Puente³⁷, Joe Patton³⁸, Ilya Rakitin³⁹, Lindsey Perea⁴⁰, Odessa Pulido⁴⁰, Hashim Ahmed⁴¹, Jane Keating⁴², Lisa M Kodadek^{43

44}, Jason Wade⁴², Henry Reynold⁴⁵, Martin Schreiber⁴⁶, Andrew Benjamin⁴⁷, Abid Khan⁴⁷, Laura K Mann⁴⁸, Caleb Mentzer⁴⁹, Vasileios Mousafeiris⁵⁰, Francesk Mulita⁵⁰, Shari Reid-Gruner⁵¹, Erica Sais⁵¹, Christopher W Foote⁵², Carlos H Palacio⁵³, Dias Argandykov⁵⁴, Haytham Kaafarani⁵⁴, Michelle T Bover Manderski⁵⁵, Lilamarie Moko¹, Mayur Narayan¹, Mark Seamon²⁴

Affiliations

¹ Surgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
² Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
³ Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
⁴ Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
⁵ Trauma/Surgical Critical Care, Emory University School of Medicine, Atlanta, Georgia, USA.
⁶ Grady Memorial Hospital Corp, Atlanta, Georgia, USA.
⁷ Temple University Hospital, Philadelphia, Pennsylvania, USA.
⁸ Surgery, Temple University, Philadelphia, Pennsylvania, USA.
⁹ R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA.
¹⁰ University of Maryland School of Medicine, Baltimore, Maryland, USA.
¹¹ Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹² Trauma/Surgical Critical Care, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
¹³ Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.
¹⁴ University of Kentucky, Lexington, Kentucky, USA.
¹⁵ Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
¹⁶ Surgery, Mount Sinai Hospital, Chicago, Illinois, USA.
¹⁷ Department of Surgery, Mount Sinai Hospital, Chicago, Illinois, USA.
¹⁸ Cooper University Hospital Regional Trauma Center, Camden, New Jersey, USA.
¹⁹ Riverside University Health System Medical Center, Moreno Valley, California, USA.
²⁰ Indiana University Health Methodist Hospital, Indianapolis, Indiana, USA.
²¹ The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
²² UT Southwestern Medical, Dallas, Texas, USA.
²³ MedStar Washington Hospital Center, Washington, District of Columbia, USA.
²⁴ University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
²⁵ WellSpan Health, York, Pennsylvania, USA.
²⁶ Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA.
²⁷ Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA.
²⁸ Boston Medical Center, Boston, Massachusetts, USA.
²⁹ University of Rochester, Rochester, New York, USA.
³⁰ Surgery, University of Rochester Medical Center, Rochester, New York, USA.
³¹ McGill University, Montreal, Quebec, Canada.
³² WakeMed Health and Hospitals, Raleigh, North Carolina, USA.
³³ Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina, USA.
³⁴ University of Arizona Medical Center - University Campus, Tucson, Arizona, USA.
³⁵ Jackson Memorial Hospital, Miami, Florida, USA.
³⁶ University of California Irvine School of Medicine, Irvine, California, USA.
³⁷ Broward Health Medical Center, Fort Lauderdale, Florida, USA.
³⁸ Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
³⁹ Henry Ford Hospital, Detroit, Michigan, USA.
⁴⁰ Lancaster General Health, Lancaster, Pennsylvania, USA.
⁴¹ Surgery, Texas Health Harris Methodist Hospital Fort Worth, Fort Worth, Texas, USA.
⁴² Hartford Hospital, Hartford, Connecticut, USA.
⁴³ Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
⁴⁴ Yale New Haven Hospital, New Haven, CT, USA.
⁴⁵ Oregon Health & Science University, Portland, Oregon, USA.
⁴⁶ Surgery, Oregon Health and Science University, Portland, Oregon, USA.
⁴⁷ The University of Chicago Medicine, Chicago, Illinois, USA.
⁴⁸ Spartanburg Regional Medical Center, Spartanburg, South Carolina, USA.
⁴⁹ Department of Surgery, University of Texas McGovern Medical School, Houston, Texas, USA.
⁵⁰ University General Hospital of Patras, Patra, Greece.
⁵¹ Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
⁵² Trauma Services Department, South Texas Health System, McAllen, Texas, USA.
⁵³ South Texas Health System, Edinburg, Texas, USA.
⁵⁴ Massachusetts General Hospital, Boston, Massachusetts, USA.
⁵⁵ Rutgers School of Public Health, Piscataway, New Jersey, USA.

PMID: 39717488
PMCID: PMC11664373
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 et al. Trauma Surg Acute Care Open. 2024.

. 2024 Dec 20;9(1):e001438.

doi: 10.1136/tsaco-2024-001438. eCollection 2024.

Authors

Affiliations

¹ Surgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
² Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
³ Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
⁴ Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
⁵ Trauma/Surgical Critical Care, Emory University School of Medicine, Atlanta, Georgia, USA.
⁶ Grady Memorial Hospital Corp, Atlanta, Georgia, USA.
⁷ Temple University Hospital, Philadelphia, Pennsylvania, USA.
⁸ Surgery, Temple University, Philadelphia, Pennsylvania, USA.
⁹ R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA.
¹⁰ University of Maryland School of Medicine, Baltimore, Maryland, USA.
¹¹ Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹² Trauma/Surgical Critical Care, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
¹³ Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.
¹⁴ University of Kentucky, Lexington, Kentucky, USA.
¹⁵ Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
¹⁶ Surgery, Mount Sinai Hospital, Chicago, Illinois, USA.
¹⁷ Department of Surgery, Mount Sinai Hospital, Chicago, Illinois, USA.
¹⁸ Cooper University Hospital Regional Trauma Center, Camden, New Jersey, USA.
¹⁹ Riverside University Health System Medical Center, Moreno Valley, California, USA.
²⁰ Indiana University Health Methodist Hospital, Indianapolis, Indiana, USA.
²¹ The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
²² UT Southwestern Medical, Dallas, Texas, USA.
²³ MedStar Washington Hospital Center, Washington, District of Columbia, USA.
²⁴ University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
²⁵ WellSpan Health, York, Pennsylvania, USA.
²⁶ Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA.
²⁷ Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA.
²⁸ Boston Medical Center, Boston, Massachusetts, USA.
²⁹ University of Rochester, Rochester, New York, USA.
³⁰ Surgery, University of Rochester Medical Center, Rochester, New York, USA.
³¹ McGill University, Montreal, Quebec, Canada.
³² WakeMed Health and Hospitals, Raleigh, North Carolina, USA.
³³ Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina, USA.
³⁴ University of Arizona Medical Center - University Campus, Tucson, Arizona, USA.
³⁵ Jackson Memorial Hospital, Miami, Florida, USA.
³⁶ University of California Irvine School of Medicine, Irvine, California, USA.
³⁷ Broward Health Medical Center, Fort Lauderdale, Florida, USA.
³⁸ Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
³⁹ Henry Ford Hospital, Detroit, Michigan, USA.
⁴⁰ Lancaster General Health, Lancaster, Pennsylvania, USA.
⁴¹ Surgery, Texas Health Harris Methodist Hospital Fort Worth, Fort Worth, Texas, USA.
⁴² Hartford Hospital, Hartford, Connecticut, USA.
⁴³ Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
⁴⁴ Yale New Haven Hospital, New Haven, CT, USA.
⁴⁵ Oregon Health & Science University, Portland, Oregon, USA.
⁴⁶ Surgery, Oregon Health and Science University, Portland, Oregon, USA.
⁴⁷ The University of Chicago Medicine, Chicago, Illinois, USA.
⁴⁸ Spartanburg Regional Medical Center, Spartanburg, South Carolina, USA.
⁴⁹ Department of Surgery, University of Texas McGovern Medical School, Houston, Texas, USA.
⁵⁰ University General Hospital of Patras, Patra, Greece.
⁵¹ Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
⁵² Trauma Services Department, South Texas Health System, McAllen, Texas, USA.
⁵³ South Texas Health System, Edinburg, Texas, USA.
⁵⁴ Massachusetts General Hospital, Boston, Massachusetts, USA.
⁵⁵ Rutgers School of Public Health, Piscataway, New Jersey, USA.

PMID: 39717488
PMCID: PMC11664373
DOI: 10.1136/tsaco-2024-001438

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.

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Conflict of interest statement

None declared.

Comment in

Pancreaticoduodenectomy in trauma patients.
Efron DT. Efron DT. Trauma Surg Acute Care Open. 2025 Jan 16;10(1):e001684. doi: 10.1136/tsaco-2024-001684. eCollection 2025. Trauma Surg Acute Care Open. 2025. PMID: 39845987 Free PMC article. No abstract available.

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

References

LinkOut - more resources

Full Text Sources

Research Materials