Surgery, Gastroenterology and Oncology

Introduction: Acute respiratory distress syndrome (ARDS) can cause severe morbidity and mortality after a pancreaticoduodenectomy (PD). However, very few studies have evaluated the risk factors for ARDS among patients undergoing abdominal surgery, with even fewer studies being performed for patients undergoing PD specifically.

Methods: We performed a retrospective chart analysis of 200 patients undergoing PD between February 2009 and April 2014 in our Department and investigated the risk factors for ARDS by analysing preoperative chest CT scan images and other clinical parameters.

Results: Among the 200 patients, interstitial patterns (IP) on preoperative lung CT images were found in 12 patients (6%, IP group). Of these, ARDS developed in 2 patients (16.7%), whereas ARDS did not occur in any of the remaining 188 patients without an IP pattern. Both of the ARDS patients died within 90 days without experiencing any other abdominal complications.
The serum KL-6 level was measured in 6 of the 12 patients in the IP group, and the KL-6 levels were higher than the normal limit for our hospital (500 U mL) in 2 patients. One of these 2 patients developed ARDS after PD. No other clinical findings or parameters predictive of ARDS after PD were found.

Conclusions: ARDS after PD can occur in patients without any history of respiratory disease and is associated with a very high operative mortality. Interstitial patterns on preoperative lung CT images may predict a risk of ARDS after PD.

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