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Purpose <p>To assess the impact of interventional radiology (IR) as first-line rescue therapy for major complications after pancreaticoduodenectomy and to quantify its effect on surgical re-exploration and 90-day mortality.</p> Materials and methods <p>In this retrospective single-center cohort, 200 consecutive patients undergoing pancreaticoduodenectomy (2014–2025) were reviewed. Complications were recorded using ISGPS/ISGLS definitions; postoperative pancreatic fistula (POPF) included biochemical leak. Patients were grouped by initial management strategy (IR-first vs. primary surgery); crossover to the alternative treatment was recorded and interpreted within a step-up management framework rather than uniformly as treatment failure. Outcomes included need for re-intervention, technical success, length of stay, and 90-day mortality. Fisher’s exact test compared mortality between strategies within clinically relevant POPF (CR-POPF) and postpancreatectomy hemorrhage (PPH) subgroups.</p> Results <p>Overall, 126/200 patients (63%) developed postoperative complications and 75/126 (59.5%) required early re-intervention. IR accounted for 63/75 reinterventions (84.0%). POPF occurred in 79/200 (39.5%); CR-POPF in 49/200 (24.5%). Among CR-POPF, 33/49 (67.3%) underwent image-guided drainage and 15/49 (30.6%) required re-exploration; 90-day mortality was lower with IR-first than surgery-first management in unadjusted analysis (5/33, 15.2% vs. 8/15, 53.3%; <i>p</i> = 0.012). PPH occurred in 26/200 (13.0%); embolization was performed in 16/26 (61.5%) with low step-up to surgery (1/16, 6.3%). Mortality did not differ significantly between embolization-only and re-exploration-only pathways (3/16, 18.8% vs. 4/8, 50.0%; <i>p</i> = 0.182). Biliary complications were managed primarily with IR in 32/33 patients (97.0%).</p> Conclusion <p>A substantial proportion of major post-pancreaticoduodenectomy complications can be controlled with minimally invasive IR techniques, limiting surgical re-exploration. IR-first strategy was associated with lower 90-day mortality in unadjusted analysis; however, this association was attenuated after adjustment for clinical severity. Prospective multicenter studies are needed to further refine selection criteria and step-up treatment algorithms.</p> Level of evidence <p>&#xa0;Level 3, therapeutic study.</p>

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Interventional radiology in the management of complications after pancreatic surgery: a single-center experience

  • 期刊论文

  • 发表日期：

    2026年7月2日

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  • Giuseppina Pacella,
  • Laura Olivieri,
  • Carlo Altomare,
  • Caterina Marsella,
  • Elva Vergantino,
  • Gaetano Russo,
  • Michele Tondo,
  • Martina Rendina,
  • Damiano Caputo,
  • Vincenzo La Vaccara,
  • Domiziana Santucci,
  • Bruno Beomonte Zobel,
  • Eliodoro Faiella,
  • Martijn R. Meijerink,
  • Rosario Francesco Grasso

摘要

Purpose

To assess the impact of interventional radiology (IR) as first-line rescue therapy for major complications after pancreaticoduodenectomy and to quantify its effect on surgical re-exploration and 90-day mortality.

Materials and methods

In this retrospective single-center cohort, 200 consecutive patients undergoing pancreaticoduodenectomy (2014–2025) were reviewed. Complications were recorded using ISGPS/ISGLS definitions; postoperative pancreatic fistula (POPF) included biochemical leak. Patients were grouped by initial management strategy (IR-first vs. primary surgery); crossover to the alternative treatment was recorded and interpreted within a step-up management framework rather than uniformly as treatment failure. Outcomes included need for re-intervention, technical success, length of stay, and 90-day mortality. Fisher’s exact test compared mortality between strategies within clinically relevant POPF (CR-POPF) and postpancreatectomy hemorrhage (PPH) subgroups.

Results

Overall, 126/200 patients (63%) developed postoperative complications and 75/126 (59.5%) required early re-intervention. IR accounted for 63/75 reinterventions (84.0%). POPF occurred in 79/200 (39.5%); CR-POPF in 49/200 (24.5%). Among CR-POPF, 33/49 (67.3%) underwent image-guided drainage and 15/49 (30.6%) required re-exploration; 90-day mortality was lower with IR-first than surgery-first management in unadjusted analysis (5/33, 15.2% vs. 8/15, 53.3%; p = 0.012). PPH occurred in 26/200 (13.0%); embolization was performed in 16/26 (61.5%) with low step-up to surgery (1/16, 6.3%). Mortality did not differ significantly between embolization-only and re-exploration-only pathways (3/16, 18.8% vs. 4/8, 50.0%; p = 0.182). Biliary complications were managed primarily with IR in 32/33 patients (97.0%).

Conclusion

A substantial proportion of major post-pancreaticoduodenectomy complications can be controlled with minimally invasive IR techniques, limiting surgical re-exploration. IR-first strategy was associated with lower 90-day mortality in unadjusted analysis; however, this association was attenuated after adjustment for clinical severity. Prospective multicenter studies are needed to further refine selection criteria and step-up treatment algorithms.

Level of evidence

 Level 3, therapeutic study.