Generalized obesity is associated with postoperative wound infections after pancreaticoduodenectomy. The degree of visceral fat on preoperative cross-sectional imaging is associated with significantly higher rates of overall complications and pancreatic fistula.

It is a commonly held belief that infiltration of immune cells into tumor tissues and direct physical contact between tumor cells and infiltrated immune cells is associated with physical destructions of the tumor cells, reduction of the tumor burden, and improved clinical prognosis. An increasing number of studies, however, have suggested that aberrant infiltration of immune cells into tumor or normal tissues may promote tumor progression, invasion, and metastasis. Neither the primary reason for these contradictory observations, nor the mechanism for the reported diverse impact of tumor-infiltrating immune cells has been elucidated, making it difficult to judge the clinical implications of infiltration of immune cells within tumor tissues. This mini-review presents several existing hypotheses and models that favor the promoting impact of tumor-infiltrating immune cells on tumor invasion and metastasis, and also analyzes their strength and weakness.

INTRODUCTION Pancreaticoduodenectomy (PD) performed for pancreatic ductal adenocarcinoma (PDA) has a postoperative morbidity of 40–50%. In this study, we analyzed the impact of high grade complications after PD for PDA on overall survival. METHODS 596 patients that underwent PD for PDA between 2001–2009 were identified from a prospective database. Complications were defined and graded (1–5) as per our Institutional Surgical Secondary Events Program. High grade complications were defined as ≥ grade 3. Postoperative mortality (≤ 90 days) was excluded. Univariate and multivariate analyses were performed to identify factors associated with overall survival. RESULTS Median survival was 24 months. Overall complication rate was 51% (301/596). Low grade complications were recorded in 266 patients (45%) and high grade complications in 22% (n= 129). Our 90 day mortality was 3.7% (n= 22). Anastomotic fistula/ leak/abscess rate was 14% (n= 82). Multivariate Cox-Regression analysis identified node positivity, estimated blood loss (EBL) > 600 ml, length of stay (LOS) > 10 days, margin positivity and vascular procedures as predictors of decreased overall survival (p < 0.05). High grade complications were not associated with overall survival (p = 0.948). CONCLUSION In this study, the occurrence of high grade postoperative complications was not associated with overall survival.

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