Elsevier

Surgery

Volume 139, Issue 5, May 2006, Pages 591-598
Surgery

Original communication
Risk factors for mortality and intra-abdominal complications after pancreatoduodenectomy: multivariate analysis in 300 patients

https://doi.org/10.1016/j.surg.2005.08.012Get rights and content

Background

Studies of risk factors after pancreatoduodenectomy are few: some concern restricted populations and others are based on administrative data.

Methods

Multicenter clinical data were collected for 300 patients undergoing pancreatoduodenectomy to determine (by univariate and multivariate analysis) preoperative and intraoperative risk factors for mortality and intra-abdominal complications (IACs), including pancreatic fistula. Fourteen factors including the center and volume effect were analyzed.

Results

In univariate analysis, mortality was increased with age 70 years or more, extended resection(s), and volume and center effects. IACs occurred more often with main pancreatic duct diameter of 3 mm or less, normal parenchyma texture, extended resection(s), and the center effect. Pancreatic fistula was more frequent with main pancreatic duct diameter of 3 mm or less, normal parenchyma texture, and the center effect. In multivariate analysis, independent risk factor(s) for mortality were age greater than 70 years (odds ratio [OR], 3; 95% confidence interval [CI], 1.3-8) and extended resection (OR, 5; 95% CI, 1.2-22), risk factors for IACs were extended resection (OR, 5; 95% CI, 1.2-22) and main pancreatic duct diameter of 3 mm or less (OR, 2; 95% CI, 1.1-3), and the risk factor for pancreatic fistula was main pancreatic duct diameter of 3 mm or less (OR, 2.5; 95% CI, 1.2-4.6).

Conclusions

Age more than 70 years, extended resections, and main pancreatic duct diameter less than 3 mm are independent risk factors that should be considered in indications for and techniques of pancreatoduodenectomy.

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)

  • V. Ho et al.

    Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy

    Ann Surg

    (2003)
  • M.W. Buchler et al.

    Changes in morbidity after pancreatic resection. Toward the end of completion pancreatectomy

    Arch Surg

    (2003)
  • C.J. Yeo et al.

    Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancraticoduodenectomy? Results of a prospective randomized placebo-controlled trial

    Ann Surg

    (2000)
  • M.W. Buchler et al.

    Pancreatic fistula after pancreatic head resection

    Br J Surg

    (2000)
  • S.M. Strasberg et al.

    Prospective trial of a blood supply-based technique of pancreatico-jejunostomyeffect of anastomotic failure in the Whipple procedure

    J Am Coll Surg

    (2002)
  • A.M. Lowy et al.

    Prospective, randomized trial of octreotide to prevent pancreatic fistula after pancreaticoduodenectomy for malignant disease

    Ann Surg

    (1997)
  • Cited by (216)

    • Risk factors predicting the development of a pancreatic fistula following pancreaticoduodenectomy: A retrospective cohort study

      2022, International Journal of Surgery Open
      Citation 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.

    View all citing articles on Scopus
    View full text