23 Pancreatoduodenectomy for Malignancy: Which Patients Are High-Risk?
T Russell, P Labib, S Aroori,- Surgery
Abstract
Aim
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.
Method
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.
Results
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).
Conclusions
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.