Pancreatoduodenectomy - Preventing Complications

Penumadu, Prasanth; Barreto, Savio George; Goel, Mahesh; Shrikhande, Shailesh V.

doi:10.1007/s13193-013-0286-z

Cited by 15 publications

(5 citation statements)

References 111 publications

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Section: Discussionsupporting

confidence: 91%

“…In the current study, the incidence of major postoperative complications was 24.6%, which is comparable with the rates reported in several other series of patients undergoing PD for PDAC. [26][27][28] Additionally, our results showed that around 30% of patients experienced an infectious complication. Indeed, the occurrence of an infectious complication was associated with worse OS compared to patients who had a noninfectious complication or an T A B L E 1 Baseline demographic and clinicopathologic variables of pancreatic ductal adenocarcinoma patients with or without postoperative infectious complications.…”

Section: Discussionsupporting

confidence: 56%

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Postoperative infectious complications worsen oncologic outcomes following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Khachfe,

Hammad,

AlMasri

et al. 2024

Journal of Surgical Oncology

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BackgroundPancreaticoduodenectomy (PD) remains the only curative option for patients with pancreatic adenocarcinoma (PDAC). Infectious complications (IC) can negatively impact patient outcomes and delay adjuvant therapy in most patients. This study aims to determine IC effect on overall survival (OS) following PD for PDAC.Study DesignPatients who underwent PD for PDAC between 2010 and 2020 were identified from a single institutional database. Patients were categorized into two groups based on whether they experienced IC or not. The relationship between postoperative IC and OS was investigated using Kaplan−Meier and Cox‐regression multivariate analysis.ResultsAmong 655 patients who underwent PD for PDAC, 197 (30%) experienced a postoperative IC. Superficial wound infection was the most common type of infectious complication (n = 125, 63.4%). Patients with IC had significantly more minor complications (Clavien‐Dindo [CD] < 3; [59.4% vs. 40.2%, p < 0.001]), major complications (CD ≥ 3; [37.6% vs. 18.8%, p < 0.001]), prolonged LOS (47.2% vs 20.3%, p < 0.001), biochemical leak (6.1% vs. 2.8%, p = 0.046), postoperative bleeding (4.1% vs. 1.3%, p = 0.026) and reoperation (9.6% vs. 2.2%, p < 0.001). Time to adjuvant chemotherapy was delayed in patients with IC versus those without (10 vs. 8 weeks, p < 0.001). Median OS for patients who experienced no complication, noninfectious complication, and infectious complication was 33.3 months, 29.06 months, and 27.58 months respectively (p = 0.023). On multivariate analysis, postoperative IC were an independent predictor of worse OS (HR 1.32, p = 0.049).ConclusionsIC following PD for PDAC independently predict worse oncologic outcomes. Thus, efforts to prevent and manage IC should be a priority in the care of patients undergoing PD for PDAC.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 56%

Postoperative infectious complications worsen oncologic outcomes following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Khachfe,

Hammad,

AlMasri

et al. 2024

Journal of Surgical Oncology

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“…All three complications are classified according to the International Study Group of Pancreatic Surgery (ISGPS) classification system [ 9 ]. DGE is the most common complication following PD with an incidence rate of 20–50% [ 3 , 10 ]. POPF is a serious and life-threatening complication with incidence rates between 5 and 40% [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

External Validation of a Risk Model for Severe Complications following Pancreatoduodenectomy Based on Three Preoperative Variables

Alhulaili

Pleijhuis

Nijkamp

et al. 2022

Cancers

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Background: Pancreatoduodenectomy (PD) is the only cure for periampullary and pancreatic cancer. It has morbidity rates of 40–60%, with severe complications in 30%. Prediction models to predict complications are crucial. A risk model for severe complications was developed by Schroder et al. based on BMI, ASA classification and Hounsfield Units of the pancreatic body on the preoperative CT scan. These variables were independent predictors for severe complications upon internal validation. Our aim was to externally validate this model using an independent cohort of patients. Methods: A retrospective analysis was performed on 318 patients who underwent PD at our institution from 2013 to 2021. The outcome of interest was severe complications Clavien–Dindo ≥ IIIa. Model calibration, discrimination and performance were assessed. Results: A total of 308 patients were included. Patients with incomplete data were excluded. A total of 89 (28.9%) patients had severe complications. The externally validated model achieved: C-index = 0.67 (95% CI: 0.60–0.73), regression coefficient = 0.37, intercept = 0.13, Brier score = 0.25. Conclusions: The performance ability, discriminative power, and calibration of this model were acceptable. Our risk calculator can help surgeons identify high-risk patients for post-operative complications to improve shared decision-making and tailor perioperative management.

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“…These observations have been published by others, as well[ 10 ]. Thus, in pancreatic surgery and especially PD, it is imperative that we investigate compliance to protocols, as well as the impact of deviations from clinical pathways[ 11 ] because herein lies the potential to improve early detection of complications with the potential to treat them in a systematic and prompt fashion preventing death[ 12 ] due to a “failure to rescue”[ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis of the impact of deviations from a clinical pathway on outcomes following pancreatoduodenectomy

Karunakaran¹,

Jonnada²,

Barreto³

2021

WJCC

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BACKGROUND Enhanced recovery after surgery is steadily gaining importance in patients undergoing pancreatic surgery, including pancreatoduodenectomy (PD). While clinical pathways targeting enhanced-recovery can achieve their intended outcome in reducing length of stay, compliance to these pathways, and their relevance is poorly understood. The aim of this systematic review was to assess the impact of deviations from/non-compliance to a clinical pathway on post-PD outcomes. AIM To assess the impact of deviations from/non-compliance to a clinical pathway on post-PD outcomes. METHODS A systematic review of major reference databases was undertaken, according to preferred reporting items for systematic reviews and meta-analysis guidelines, between January 2000 and November 2020 relating to compliance with clinical pathways and its impact on outcomes in patients undergoing PD. A meta-analysis was performed using fixed-effects or random-effects models. RESULTS Eleven studies including 1852 patients were identified. Median overall compliance to all components of the clinical pathway was 65.7% [interquartile range (IQR): 62.7%-72.3%] with median compliance to post-operative parameters of the clinical pathway being 44% (IQR: 34.5%-52.25%). Meta-analysis using a fixed-effects model showed that ≥ 50% compliance to a clinical pathway predicted significantly fewer post-operative complications [pooled odds ratio (OR): 9.46, 95% confidence interval (CI): 5.00-17.90; P < 0.00001] and a significantly shorter length of hospital stay [pooled mean difference (MD): 4.32, 95%CI: -3.88 to -4.75; P < 0.0001]. At 100% compliance which was associated with significantly fewer post-operative complications (pooled OR: 11.25, 95%CI: 4.71-26.84; P < 0.00001) and shorter hospital stay (pooled MD of 4.66, 95%CI: 2.81-6.51; P < 0.00001). CONCLUSION Compliance to post-PD clinical pathways remains low. Deviations are associated with an increased risk of complications and length of hospital stay. Under-standing the relevance of deviations to clinical pathways post-PD presents pancreatic surgeons with opportunities to actively pursue an enhanced-recovery of their patients.

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Pancreatoduodenectomy - Preventing Complications

Cited by 15 publications

References 111 publications

Postoperative infectious complications worsen oncologic outcomes following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Postoperative infectious complications worsen oncologic outcomes following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

External Validation of a Risk Model for Severe Complications following Pancreatoduodenectomy Based on Three Preoperative Variables

Systematic review and meta-analysis of the impact of deviations from a clinical pathway on outcomes following pancreatoduodenectomy

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