BJS 2 Pancreatoduodenectomy for malignancy: which patients are high-risk? Results from an international multicentre cohort study
Thomas Russell, Peter Labib, Somaiah Aroori,- Surgery
Abstract
Aims
Pancreatoduodenectomy (PD) is indicated in fit patients with a resectable cancer affecting the pancreatic head but morbidity rates remain high. This study aimed to identify risk factors for postoperative complications and perioperative mortality.
Methods
Data were extracted from the Recurrence After Whipple's (RAW) study, a retrospective cohort study of PD patients with confirmed malignancy (29 centres, eight countries). Patients who experienced any complication, 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
1348 patients were included. Any complication, major morbidity, CR-POPF, PPH and 90-day mortality affected 53.4%, 16.9%, 10.5%, 6.2% and 3.8% of patients, respectively. Following a multivariable analysis, high body mass index (BMI, OR: 1.1, p=0.007), American Society of Anesthesiologists (ASA) grade >II (OR: 2.2, p<0.0001) and a pylorus-resecting approach (OR: 1.6, p=0.005) correlated with overall morbidity. ASA >II patients were at increased risk of major morbidity (OR: 2.2, p<0.0001) and a raised BMI was a risk factor for CR-POPF (OR: 1.1, p=0.001). ASA >II (OR: 2.5, p=0.002) and positive lymph nodes on preoperative imaging (OR: 2.1, p=0.01) were risk factors for PPH, and both preoperative diabetes (OR: 0.4, p<0.05) and a pancreato-jejunostomy anastomosis (OR: 0.5, p=0.03) were protective. No risk factors for 90-day mortality were identified.
Conclusion
In our study, a high BMI and ASA grade >II were associated with adverse perioperative outcomes. Patients in these groups should be made aware of their increased risk prior to surgery.