Outcomes after pancreaticoduodenectomy with or without preoperative hyperbaric oxygen therapy.

Background: Hyperbaric oxygen (HBO) therapy is an alternative method against the deleterious effects of ischemic/reperfusion (I/R) injury and its inflammatory response. This study assessed the effect of preoperative HBO on patients undergoing pancreaticoduodenectomy.

Study Design: Patients were randomized via a computer-generated algorithm. Patients in the HBO cohort received two sessions of HBO the evening before and the morning of surgery. Measurements of inflammatory mediators and self-assessed pain scales were determined pre-and postoperatively. In addition, perioperative variables and long-term survival were collected and analyzed. Data are presented as median (mean ± SD).

Results: 33 patients were included; 17 received preoperative HBO, and 16 did not. There were no intraoperative or postoperative statistical differences between patients with or without preoperative HBO. Erythrocyte sedimentation rate (ESR), IL-6, and IL-10 increased slightly before returning to normal, while TGF-alpha decreased before increasing. However, there were no differences with or without HBO. At postoperative day 30, the pain level measured with VAS score (Visual Analog Score) was lower after HBO (1 ± 1.3 vs. 3 ± 3.0, p=0.05). Eleven (76%) patients in the HBO cohort and 12 (75%) patients in the non- HBO had malignant pathology. The percentage of positive lymph nodes in the HBO was 7% compared to 14% in the non-HBO (p<0.001). Overall survival was inferior after HBO compared to the non- HBO (p=0.03).

Conclusions: Preoperative HBO did not affect perioperative outcomes or significantly change the inflammatory mediators for patients undergoing robotic pancreaticoduodenectomy. Long-term survival was inferior after preoperative HBO. Further randomized controlled studies are required to assess the full impact of this treatment on patients' prognosis.