Modern endovascular treatment strategies in the management of postpancreatectomy haemorrhage in patients with pancreatic cancer

Abstract

Objective — to determine the occurrence and management of postpancreatectomy haemorrhage in pancreatic cancer patients, as well as to identify effective treatment strategies to improve patient outcomes.

Materials and methods. From January 2010 to December 2022, 878 patients who underwent radical pancreatic resections for malignant tumours were retrospectively analysed.

Patients were divided into two groups. The main group consisted of 500 patients who were treated in the clinic from 2016 to 2022. In the main group, postpancreatectomy haemorrhage occurred in 31 (6.2%) patients. These patients were treated according to our diagnostic and treatment algorithm, using endovascular techniques as the first step of treatment. The comparison group consisted of 378 patients who were treated in our department from 2010 to 2015. In the comparison group, postpancreatectomy haemorrhage occurred in 20 (5.3%) patients. These patients were treated according to standard approaches. The definition of postpancreatectomy haemorrhage proposed by the International Study Group of Pancreatic Surgery was used in our research.

Results. Out of 31 patients in the main group, 16 (51.6%) had endovascular embolisation. A total of 10 patients underwent endovascular occlusion, whereas 5 patients experienced cessation of bleeding with the use of a stent graft. Angiography did not detect the cause of bleeding in 3 (9.7%) individuals in the main group. They underwent laparotomy with subsequent haemostasis. 11 (35.5%) patients underwent open surgical interventions. In the main group, one (3.2%) patient died due to the emergence of infectious complications after laparotomy and subsequent haemostasis. 2 (10%) patients underwent endovascular haemostasis, while 15 (75%) patients underwent relaparotomy with haemostasis. In the comparison group, 6 (30%) patients died after open relaparotomies.

Conclusions. The initial course of action for managing postpancreatectomy haemorrhage involves the implementation of endovascular techniques, wherein stent grafts are used to address bleeding originating from the main blood vessel. The application of advanced treatment strategies that optimised the use of minimally invasive endovascular techniques resulted in a notable decrease in the mortality rate associated with postpancreatectomy bleeding from 30% to 3.2% (χ²=7.3, p=0.006). Ensuring 24/7 access to endovascular treatment, which can be provided exclusively in high‑volume centres, is imperative for improving the treatment outcomes of patients with pancreatic and periampullary cancer.