Preoperative Factors Predict Perioperative Morbidity and Mortality After Pancreaticoduodenectomy

Greenblatt, David Yü; Kelly, Kaitlyn J.; Rajamanickam, Victoria; Yin, Wei; Hanson, Thomas L.; Rettammel, Robert J.; Winslow, Emily R.; Cho, Clifford S.; Weber, Sharon M.

doi:10.1245/s10434-011-1594-6

Cited by 255 publications

(178 citation statements)

References 27 publications

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“…Analysis of the American College of Surgeons National Surgical Quality Improvement Program database revealed increased 30-day mortality after pancreaticoduodenectomy among patients who received preoperative radiation therapy (15). One case series demonstrated a 37.5% rate of portal vein (PV) stenosis after neoadjuvant chemoradiotherapy and pancreatectomy (16).…”

Section: Introductionmentioning

confidence: 99%

Favorable perioperative outcomes after resection of borderline resectable pancreatic cancer treated with neoadjuvant stereotactic radiation and chemotherapy compared with upfront pancreatectomy for resectable cancer

Mellon¹,

Ström²,

Hoffe³

et al. 2016

J. Gastrointest. Oncol.

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Background: Neoadjuvant multi-agent chemotherapy and stereotactic body radiation therapy (SBRT) are utilized to increase margin negative (R0) resection rates in borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) patients. Concerns persist that these neoadjuvant therapies may worsen perioperative morbidities and mortality.Methods: Upfront resection patients (n=241) underwent resection without neoadjuvant treatment for resectable disease. They were compared to BRPC or LAPC patients (n=61) who underwent resection after chemotherapy and 5 fraction SBRT. Group comparisons were performed by Mann-Whitney U or Fisher's exact test. Overall Survival (OS) was estimated by Kaplan-Meier and compared by log-rank methods.Results: In the neoadjuvant therapy group, there was significantly higher T classification, N classification, and vascular resection/repair rate. Surgical positive margin rate was lower after neoadjuvant therapy (3.3% vs. 16.2%, P=0.006). Post-operative morbidities (39.3% vs. 31.1%, P=0.226) and 90-day mortality (2% vs. 4%, P=0.693) were similar between the groups. Median OS was 33.5 months in the neoadjuvant therapy group compared to 23.1 months in upfront resection patients who received adjuvant treatment (P=0.057). Conclusions:Patients with BRPC or LAPC and sufficient response to neoadjuvant multi-agent chemotherapy and SBRT have similar or improved peri-operative and long-term survival outcomes compared to upfront resection patients.

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Section: Introductionmentioning

confidence: 99%

Favorable perioperative outcomes after resection of borderline resectable pancreatic cancer treated with neoadjuvant stereotactic radiation and chemotherapy compared with upfront pancreatectomy for resectable cancer

Mellon¹,

Ström²,

Hoffe³

et al. 2016

J. Gastrointest. Oncol.

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“…4 Male sex, emergency surgery, COPD, bleeding disorders, and blood urea nitrogen less than 8 mg/dL were independent variables in the 30day mortality group. 4 Although age is a risk factor, current studies suggest that PD is an acceptable option for elderly patients. 5 In a review of outcomes of PD completed on 385 patients, 23 patients who were 80 years or older were assessed from 1998 to 2011.…”

Section: Factors Associated With Postoperative Complicationsmentioning

confidence: 93%

“…4 Significant predictors of 30day mortality included COPD, hypertension, neoadjuvant radiation therapy, elevated serum creatinine, and hypoalbuminemia. Japanese studies have demonstrated that risk factors for inhospital mortality were age, respiratory distress, activities of daily living within 30 days before surgery, angina, weight loss of more than 10%, American Society of Anesthesiologist class greater than 3, Brinkman index of more than 400, body mass index (BMI) of more than 25 kg/m 2 , white blood cell count of more than 11,000 cells/µL, platelet count of less than 120,000/µL, prothrombin time/international normal ized ratio of more than 1.1, activated partial thromboplastin time of more than 40 seconds, and serum creatinine levels of more than 3 mg/dL.…”

Section: Factors Associated With Postoperative Complicationsmentioning

confidence: 99%

“…Japanese studies have demonstrated that risk factors for inhospital mortality were age, respiratory distress, activities of daily living within 30 days before surgery, angina, weight loss of more than 10%, American Society of Anesthesiologist class greater than 3, Brinkman index of more than 400, body mass index (BMI) of more than 25 kg/m 2 , white blood cell count of more than 11,000 cells/µL, platelet count of less than 120,000/µL, prothrombin time/international normal ized ratio of more than 1.1, activated partial thromboplastin time of more than 40 seconds, and serum creatinine levels of more than 3 mg/dL. 4 Male sex, emergency surgery, COPD, bleeding disorders, and blood urea nitrogen less than 8 mg/dL were independent variables in the 30day mortality group. 4 Although age is a risk factor, current studies suggest that PD is an acceptable option for elderly patients.…”

Section: Factors Associated With Postoperative Complicationsmentioning

confidence: 99%

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Whipple procedure: patient selection and special considerations

Tan-Tam¹,

Segedi²,

Chung³

2016

OAS

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At the inception of pancreatic surgery by Dr Whipple in 1930s, the mortality and morbidity risk was more than 20%. With further understanding of disease processes and improve ments in pancreas resection techniques, the mortality risk has decreased to less than 5%. Age and chronic illnesses are no longer a contraindication to surgical treatment. Life expectancy and quality of life at a later age have improved, making older patients more likely to receive pancreatic surgery, thereby also putting emphasis on operative patient selection to minimize complica tions. This review summarizes the benign and malignant illnesses that are treated with pancreas operations, and innovations and improvements in pancreatic surgery and perioperative care, and describes the careful selection process for patients who would benefit from an operation. These indications are not reserved only to Whipple operation, but to pancreatectomies as well.

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“…Most previous outcome studies have grouped patients' diagnoses by benign and malignant disease categories; [17][18][19] this categorization scheme may not be the best method to assess risk and predict outcomes because it does not consider gland size or texture. A recent study from our institution has shown that stratifying patients by diagnosis (and, thus, gland size and texture) can predict risk for postoperative complications in patients of all ages presenting for PD.…”

Section: Introductionmentioning

confidence: 99%

Risk by indication for pancreaticoduodenectomy in patients 80 years and older: a study from the American College of Surgeons National Surgical Quality Improvement Program

Bergquist¹,

Shubert²,

Ubl³

et al. 2016

HPB

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Background: Expected mortality after elective pancreaticoduodenectomy (PD) in contemporary series is less than 5% in elderly patients; however, to our knowledge, mortality rate has not been correlated with indication for PD. We hypothesized that perioperative risk following PD would correlate with diagnostic indication in older patients. Methods:The American College of Surgeons NSQIP database was reviewed to identify patients (<80 and 80 years) who underwent PD from January 1, 2005, through December 31, 2012. High-and low-risk diagnoses were determined by using 30-day, major-morbidity data. Univariate and multivariable analyses were used to compare outcomes.Results: Pancreatic cancer and chronic pancreatitis were found to be low-risk diagnoses in elderly patients, whereas bile duct and ampullary neoplasm, duodenal neoplasm, and neuroendocrine tumors were high-risk diagnoses. The risk of 30-day mortality for older patients (80 y) undergoing PD was 6.1% for those with high-risk diagnoses vs 4.5% for those with low-risk diagnoses (P = .27). On multivariable analysis (controlling for confounders), a high-risk diagnosis was shown to be an independent predictor of prolonged length of stay, superficial surgical-site infection (SSI), and organ-space SSI. There was no increased risk of complications in patients 80 years with low-risk diagnoses. Conclusion:In patients 80 or older undergoing PD, perioperative risk varies by diagnostic indication.Patients should receive preoperative counseling about their risk.

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Preoperative Factors Predict Perioperative Morbidity and Mortality After Pancreaticoduodenectomy

Cited by 255 publications

References 27 publications

Favorable perioperative outcomes after resection of borderline resectable pancreatic cancer treated with neoadjuvant stereotactic radiation and chemotherapy compared with upfront pancreatectomy for resectable cancer

Favorable perioperative outcomes after resection of borderline resectable pancreatic cancer treated with neoadjuvant stereotactic radiation and chemotherapy compared with upfront pancreatectomy for resectable cancer

Whipple procedure: patient selection and special considerations

Risk by indication for pancreaticoduodenectomy in patients 80 years and older: a study from the American College of Surgeons National Surgical Quality Improvement Program

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