Postoperative complications after pancreatoduodenectomy for malignancy: results from the Recurrence After Whipple’s (RAW) study
Author:
Russell Thomas B1ORCID, Labib Peter L1, Denson Jemimah1, Streeter Adam23ORCID, Ausania Fabio4, Pando Elizabeth5, Roberts Keith J6, Kausar Ambareen7, Mavroeidis Vasileios K89, Marangoni Gabriele10, Thomasset Sarah C11, Frampton Adam E12, Lykoudis Pavlos13, Maglione Manuel14ORCID, Alhaboob Nassir15, Bari Hassaan16, Smith Andrew M17, Spalding Duncan18, Srinivasan Parthi19, Davidson Brian R20, Bhogal Ricky H9, Croagh Daniel21, Dominguez Ismael22, Thakkar Rohan23, Gomez Dhanny24, Silva Michael A25, Lapolla Pierfrancesco26, Mingoli Andrea26, Porcu Alberto27, Shah Nehal S28, Hamady Zaed Z R29, Al-Sarrieh Bilal A30, Serrablo Alejandro31, Aroori Somaiah, Labib Peter L, Russell Thomas B, Streeter Adam, Denson Jemimah, Sheridan David, Puckett Mark, Browning Matthew G, Ausania Fabio, Gonzalez-Abos Carolina, Pando Elizabeth, Fernandes Nair, Moller Elsa Garcia, Taboada Cristina Dopazo, Roberts Keith J, Pande Rupaly, Alfarah Jameel, Kausar Ambareen, Bandyopadhyay Samik, Abdelrahim Ahmed, Khan Ayesha, Mavroeidis Vasileios K, Jordan Caitlin, Rees Jonathan R E, Marangoni Gabriele, Blege Harry, Thomasset Sarah C, Cambridge William, White Olga, Frampton Adam E, Blacker Sarah, Blackburn Jessie, Sweeney Casie, Lykoudis Pavlos, Field Daniel, Gouda Mohammed, Maglione Manuel, Bellotti Ruben, Alhaboob Nassir, Hamid Hytham K S, Bari Hassaan, Ahmed Hassan, Smith Andrew M, Moriarty Catherine, White Louise, Priestley Mark, Bode Kerry, Sharp Judith, Wragg Rosie, Jackson Beverley, Craven Samuel, Spalding Duncan, Fehervari Matyas, Pai Madhava, Alghazawi Laith, Onifade Anjola, Srinivasan Parthi, Ribaud Julliette, Nair Ashitha, Mariathasan Michael, Grayson Niamh, Davidson Brian R, Pericleous Stephanos, Patel Krishna, Shaw Conrad, Morare Nolitha, Zaban Mohamad Khish, Bhogal Ricky H, Doyle Joseph, Mavroeidis Vasileios K, Croagh Daniel, Dominguez Ismael, Guerrero Alan, Moguel Andre, Chan Carlos, Thakkar Rohan, Jones Michael, Buckley Edward, Akter Nasreen, Treherne Kyle, Gomez Dhanny, Gordon Gregory, Silva Michael A, Hughes Daniel, Urbonas Tomas, Lapolla Pierfrancesco, Mingoli Andrea, Brachini Gioia, Caronna Roberto, Chirletti Piero, Porcu Alberto, Perra Teresa, Shah Nehal S, Kahar Nurul Nadhirah Abd, Hall Thomas, Nadeem Nabeegh, Hamady Zaed Z R, Karar Shoura, Arshad Ali, Al-Sarrieh Bilal, Yarwood Adam, Hammoda Mohammed, Serrablo Alejandro, Artigas Maria, Paterna-López Sandra, Aroori Somaiah1ORCID,
Affiliation:
1. Department of HPB Surgery, University Hospitals Plymouth NHS Trust , Plymouth , UK 2. Department of Medical Statistics, University of Muenster , Muenster , Germany 3. University of Plymouth Department of Medical Statistics, , Plymouth , UK 4. Department of HPB Surgery, Hospital Clínic de Barcelona , Barcelona , Spain 5. Department of HPB Surgery, Hospital Universitari Vall d’Hebron , Barcelona , Spain 6. Department of HPB Surgery, University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK 7. Department of HPB Surgery, East Lancashire Hospitals NHS Trust , Blackburn , UK 8. Department of HPB Surgery, University Hospitals Bristol and Weston NHS Foundation Trust , Bristol , UK 9. Department of HPB Surgery, The Royal Marsden NHS Foundation Trust , London , UK 10. Department of HPB Surgery, University Hospital Coventry & Warwickshire , Coventry , UK 11. Department of HPB Surgery, NHS Lothian , Edinburgh , UK 12. Department of HPB Surgery, Royal Surrey NHS Foundation Trust , Guildford , UK 13. Department of HPB Surgery, Hull University Teaching Hospitals NHS Trust , Hull , UK 14. Department of HPB Surgery, Medical University of Innsbruck , Innsbruck , Austria 15. Department of HPB Surgery, Ibn Sina Specialized Hospital , Khartoum , Sudan 16. Department of HPB Surgery, Shaukat Khanum Memorial Cancer Hospital , Lahore , Pakistan 17. Department of HPB Surgery, Leeds Teaching Hospitals NHS Trust , Leeds , UK 18. Department of HPB Surgery, Imperial College Healthcare NHS Trust , London , UK 19. Department of HPB Surgery, King’s College Hospital NHS Foundation Trust , London , UK 20. Department of HPB Surgery, Royal Free London NHS Foundation Trust , London , UK 21. Department of HPB Surgery, Monash Medical Centre , Melbourne , Australia 22. Department of HPB Surgery, Salvador Zubiran National Institute of Health Sciences and Nutrition , Mexico City , Mexico 23. Department of HPB Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK 24. Department of HPB Surgery, Nottingham University Hospitals NHS Trust , Nottingham , UK 25. Department of HPB Surgery, Oxford University Hospitals NHS Foundation Trust , Oxford , UK 26. Department of HPB Surgery, Policlinico Umberto I University Hospital Sapienza , Rome , Italy 27. Department of HPB Surgery, Azienda Ospedaliero Universitaria di Sassari , Sassari , Italy 28. Department of HPB Surgery, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield , UK 29. Department of HPB Surgery, University Hospital Southampton NHS Foundation Trust , Southampton , UK 30. Department of HPB Surgery, Swansea Bay University Health Board , Swansea , UK 31. Department of HPB Surgery, Hospital Universitario Miguel Servet , Zaragoza , Spain
Abstract
Abstract
Background
Pancreatoduodenectomy (PD) is associated with significant postoperative morbidity. Surgeons should have a sound understanding of the potential complications for consenting and benchmarking purposes. Furthermore, preoperative identification of high-risk patients can guide patient selection and potentially allow for targeted prehabilitation and/or individualized treatment regimens. Using a large multicentre cohort, this study aimed to calculate the incidence of all PD complications and identify risk factors.
Method
Data were extracted from the Recurrence After Whipple’s (RAW) study, a retrospective cohort study of PD outcomes (29 centres from 8 countries, 2012–2015). The incidence and severity of all complications was recorded and potential risk factors for morbidity, major morbidity (Clavien–Dindo grade > IIIa), postoperative pancreatic fistula (POPF), post-pancreatectomy haemorrhage (PPH) and 90-day mortality were investigated.
Results
Among the 1348 included patients, overall morbidity, major morbidity, POPF, PPH and perioperative death affected 53 per cent (n = 720), 17 per cent (n = 228), 8 per cent (n = 108), 6 per cent (n = 84) and 4 per cent (n = 53), respectively. Following multivariable tests, a high BMI (P = 0.007), an ASA grade > II (P < 0.0001) and a classic Whipple approach (P = 0.005) were all associated with increased overall morbidity. In addition, ASA grade > II patients were at increased risk of major morbidity (P < 0.0001), and a raised BMI correlated with a greater risk of POPF (P = 0.001).
Conclusion
In this multicentre study of PD outcomes, an ASA grade > II was a risk factor for major morbidity and a high BMI was a risk factor for POPF. Patients who are preoperatively identified to be high risk may benefit from targeted prehabilitation or individualized treatment regimens.
Publisher
Oxford University Press (OUP)
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