DOI: 10.1093/bjs/znad258.068 ISSN:

23 Pancreatoduodenectomy for Malignancy: Which Patients Are High-Risk?

T Russell, P Labib, S Aroori,
  • Surgery



In the absence of metastases, pancreatoduodenectomy (PD) is indicated in fit patients with a resectable pancreatic head/periampullary cancer. Surgeons should have a sound understanding of its complication profile for consenting purposes and to benchmark their complication rates. This study aimed to calculate the overall incidence of PD complications and identify risk factors.


A multicentre retrospective cohort study of PD patients with confirmed malignancy was conducted (29 centres from 8 countries). The incidence and severity of all recorded complications was calculated. Patients who experienced any complication, major morbidity, clinically relevant postoperative pancreatic fistula (CR-POPF), post-pancreatectomy haemorrhage (PPH) and 90-day mortality were compared to those who did not experience these outcomes.


In the 1348 included patients, overall morbidity and 90-day mortality were 53% and 4%, respectively. In total, 1340 complications were recorded; 72%, 18%, 6% and 4% of these were Clavien-Dindo (CD) grades I-II, III, IV and V, respectively. CR-POPF, PPH, chyle leak, bile leak and gastro-jejunal leak affected 8%, 6%, 4%, 3% and 2% of patients, respectively. Following a multivariable analysis, high body mass index (BMI, p = 0.007), American Society of Anesthesiologists (ASA) grade >II (p<0.0001) and a pylorus-resecting approach (p = 0.005) correlated with overall morbidity. In addition, ASA grade >II patients were at increased risk of major morbidity (p<0.0001) and a raised BMI correlated with CR-POPF (p = 0.001).


In our study, over 50% of PD patients experienced morbidity. However, most complications were CD grade I-II. High BMI, ASA grade >II and a pylorus-resecting approach were all associated with the studied adverse outcomes.

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