Original communicationRisk factors for mortality and intra-abdominal complications after pancreatoduodenectomy: multivariate analysis in 300 patients
Section snippets
Patients
Data originated from 300 consecutive patients (114 women and 186 men) undergoing PD, with a mean age of 58.5 ± 12 years (range, 22-81 y) including 149 patients entered into a prospective randomized trial comparing pancreatojejunostomy and pancreatogastrostomy after PD, which ran from September 1995 to December 1999 (ie, 52 mo),23 and 151 further nonrandomized patients undergoing PD performed between January 2000 and December 2001 (24 mo) by surgeons belonging to the same research group.
Postoperative mortality and risk factors
Twenty-eight patients (9%) died postoperatively. Fifteen (5%) with IACs alone, 7 (2.5%) with EACs alone, and 6 (2%) with both. Among the 21 patients who had IACs, 9 (3%) died with more than 1 IAC and 12 (4%) died with the following isolated IACs: hemorrhage (n = 5), pancreatic fistula (n = 3), intra-abdominal collections (n = 2), and liver necrosis and acute pancreatitis (n = 1 each). Most (n = 270) patients were ASA class 1 or 2, but 30 patients were American Society of Anesthesiologists (ASA)
Discussion
In our study we found 3 independent risk factors: age greater than 70 years for mortality alone; extended resections for mortality and IACs; and main pancreatic duct diameter less than 3 mm for IACs and pancreatic fistula.
The overall mortality rate was 9%, close to the upper limit of the 0% to 10% range reported in the literature since 20001, 2, 4, 7, 16 and more recently by Ho and Heslin3 in a population-based study (9.5%), but lower than the 11.1% rate reported in the Veterans Hospital study.
References (33)
- et al.
Efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resectionsa prospective, controlled, randomized clinical trial
Surgery
(1995) - et al.
Risk factors for complications after pancreatic head resection
Am J Surg
(2004) The potent somatostatin analogue vapreotide does not decrease pancreas-specific complications after elective pancreatectomya prospective, multicenter, double-blinded, randomized, placebo-controlled trial
J Am Coll Surg
(2003)- et al.
A controlled randomized multicenter trial of pancreatogastrostomy or pancreatojejunostomy following pancreatoduodenectomy
Am J Surg
(2005) - et al.
Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy
Surgery
(1999) - et al.
Role of Octreotide in the prevention of postoperative complications following pancreatic resection
Am J Surg
(1992) - et al.
Pancreatic juice output after pancreatectomy in relation to pancreatic consistency, duct size, and leakage
Surgery
(1996) - et al.
Duct-to-mucosa versus end-to-side pancreaticojejunostomy reconstruction after pancreaticoduodenectomyresults of a prospective randomized trial
Surgery
(2003) - et al.
Rates of complications and death after pancreaticoduodenectomyrisk factors and the impact of hospital volume
Ann Surg
(2000) - et al.
Quality of complication reporting in the surgical literature
Ann Surg
(2002)
Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy
Ann Surg
Changes in morbidity after pancreatic resection. Toward the end of completion pancreatectomy
Arch Surg
Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancraticoduodenectomy? Results of a prospective randomized placebo-controlled trial
Ann Surg
Pancreatic fistula after pancreatic head resection
Br J Surg
Prospective trial of a blood supply-based technique of pancreatico-jejunostomyeffect of anastomotic failure in the Whipple procedure
J Am Coll Surg
Prospective, randomized trial of octreotide to prevent pancreatic fistula after pancreaticoduodenectomy for malignant disease
Ann Surg
Cited by (216)
Risk factors predicting the development of a pancreatic fistula following pancreaticoduodenectomy: A retrospective cohort study
2022, International Journal of Surgery OpenCitation Excerpt :In 2016, there was an update of this definition to limit the reporting of a POPF to those that affect the postoperative course of the patient [19]. As reported in several studies, the risk factors that affect the incidence of a POPF are sex, preoperative jaundice, operative time, blood transfusion, pancreatic duct diameter, and soft pancreatic parenchyma [20–26]. The present study aimed to analyze the risk factors that predict the development of a pancreatic fistula following PD and its associated morbidity and mortality.
Safety and effectiveness of open pancreaticoduodenectomy in adults aged 70 or older: A meta-analysis
2021, Journal of Geriatric Oncology