Surgical management of biliary strictures due to chronic pancreatitis: a prospective non-randomized study

Abstract

Introduction: Outcomes from selected patient series and trials excluding old and frail patients may underestimate the real burden of complications after pancreatoduodenectomies. The aim of this study was to describe the outcomes after pancreatoduodenectomy in an unselected cohort with follow-up beyond in-hospital data. Methods: An observational, cohort study from the National Patient Registry (NPR) for the period of 2012e2016 including all pancreatoduodenectomies in Norway. Outcome measures were 90-d mortality, rate of reoperation (relaparotomy) and readmissions, and all nights spent in any hospital within 30 days from index surgery (aggregated Length-of-Stay, a-LoS). Results: Some 930 patients underwent pancreatoduodenectomy during the study period. The 90-day mortality rate was 3.7% (n = 34). Reoperation rate was 14.1% (n = 131) and 18.3% (n = 24) of reoperations were performed outside index hospital. Readmission rate was 12.4% (n = 115). Median a-LoS was 14 days (IQR 10e 21). In multivariate analysis, male patients had significantly higher 90-day mortality and reoperation rate compared to women, and 90-day mortality rates increased significantly for both genders if aged !65 years. Vascular reconstruction (national rate 14.9%) was not associated with mortality or reoperation. Multi-visceral resection (national rate 4.7%) was associated with reoperation but not mortality. The national pancreatoduodenectomy resection rate was 3.4/100 000 inhabitants per year. Ageand gender adjusted resection rates did not differ between the geographical regions (p = 0.929), and the outcomes were comparable.