ArticleAbdominal radiology (New York)2026
Interventional radiology in the management of complications after pancreatic surgery: a single-center experience.
Article in Abdominal radiology (New York), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo 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
methodsIn 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.
resultsOverall, 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%).
conclusionA 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.
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