Contemporary outcomes of pancreaticoduodenectomy for benign and precancerous cystic lesions |
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| Institution: | 1. Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN 55905, USA;2. Department of Surgery, Medical University of Vienna, General Hospital, Vienna, Austria;1. Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA;2. Division of Transplant and Hepatobiliary Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA;1. Department of Hepatobiliary Pancreatic Tumor Center, Chongqing University Cancer Hospital, Chongqing, 400030, China;2. Department of Liver Surgery & Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, China;3. Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510006, China;1. Department of General Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA;2. Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, 14642, USA;3. Department of Surgical Oncology, University of Rochester Medical Center, Rochester, NY, 14642, USA;4. Department of Solid Organ Transplant Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA;1. Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle Upon Tyne, UK;2. Department of Surgery, Queen Elizabeth Hospital, Birmingham, UK;3. College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK;4. The University of Edinburgh Medical School, Edinburgh, UK;5. GI and HPB Surgical Service, Tata Memorial Hospital, Mumbai, India;6. Department of Surgery, Memorial Sloan Kettering Cancer Centre, NY, USA;7. Department of General Surgery, Instituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy |
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| Abstract: | BackgroundThe decision to undertake pancreaticoduodenectomy for benign and precancerous lesions has historically relied on outcomes data from operations for cancer. We aimed to describe risks for these specific patients and identify the highest risk groups.MethodsThe ACS-NSQIP pancreatic targeted data was queried for pancreaticoduodenectomies for benign and pre-cancerous neoplasms from 2014 to 2018. Baseline characteristics, operative techniques and outcomes were examined. Multivariate regression was performed to identify predictors of major complications.Results748 patients underwent pancreaticoduodenectomy for (n = 541,72.3%) IPMN, (n = 87,11.6%) MCN, (n = 78,10.4%) serous cystadenoma, and (n = 42,5.6%) solid pseudopapillary neoplasm. Median LOS was 8 days. Major complications (n = 135,18.0%), non-home discharges (n = 83,11.1%) and readmissions (n = 153,20.5%) occurred frequently. In patients ≥ 80 years of age (n = 37), major complications (n = 11,29.7%) and non-home discharge (n = 9,24.3%) were quite common. 5-item modified frailty index ≥ 0.4 (OR 1.84,95%CI 1.06–3.19,p = 0.030), Male sex (OR 1.729,95%CI 1.152–2.595,p = 0.008), Age ≥ 65 (OR 1.63,95%CI 1.05–2.54,p = 0.29) and African-American race (OR 2.50,95%CI 1.22–5.16,p = 0.013) were independent predictors of major morbidity.ConclusionsPancreaticoduodenectomies in this setting have high rates of major complications. Morbidity extends beyond the index hospitalization, with frequent readmission and non-home discharge. Patient specific factors, rather than technical or disease factors predicted outcomes. In certain patients, particularly those older than 80, the morbidity of this operation may exceed the cancer prevention benefits. |
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