Major Complications Independently Increase Long-Term Mortality After Pancreatoduodenectomy for Cancer.

Autor: Sandini M; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman ST, Boston, MA, 02114-02115, USA., Ruscic KJ; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA., Ferrone CR; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman ST, Boston, MA, 02114-02115, USA., Qadan M; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman ST, Boston, MA, 02114-02115, USA., Eikermann M; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA., Warshaw AL; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman ST, Boston, MA, 02114-02115, USA., Lillemoe KD; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman ST, Boston, MA, 02114-02115, USA., Castillo CF; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman ST, Boston, MA, 02114-02115, USA. cfernandez@mgh.harvard.edu.
Jazyk: angličtina
Zdroj: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2019 Oct; Vol. 23 (10), pp. 1984-1990. Date of Electronic Publication: 2018 Sep 17.
DOI: 10.1007/s11605-018-3939-y
Abstrakt: Background: Postoperative major morbidity has been associated with worse survival gastrointestinal tumors. This association remains controversial in pancreatic cancer (PC). We analyzed whether major complications after surgical resection affect long-term survival.
Methods: Records of all PC patients resected from 2007 to 2015 were reviewed. Major morbidity was defined as any grade-3 or higher 30-day complications, per the Clavien-Dindo Classification. Patients who died within 90 days after surgery were excluded from survival analysis.
Results: Of 616 patients, 81.7% underwent pancreatoduodenectomy (PD) and 18.3% distal pancreatectomy (DP). Major complications occurred in 19.1% after PD and 15.9% after DP. In patients who survived > 90 days, the likelihood of receiving adjuvant treatment was 43.9% if major complications had occurred, vs. 68.5% if not (p < 0.001), and those who received it started the treatment median 10 days later compared with uncomplicated patients (median 60 days (50-72) vs. 50 days (41-61), p = 0.001). By univariate analysis, in addition to the conventional pathology-related prognostic determinants and the receipt of adjuvant treatment, major complications worsened long-term survival after PD (median OS 26 months vs. 15, p = 0.008). A difference was also seen after DP, but it did not reach statistical significance, likely related to the small sample size (median OS 33 months vs. 18, p = 0.189). At multivariate analysis for PD, major postoperative complications remained independently associated with worse survival [HR 1.37, 95%CI (1.01-1.86)].
Conclusions: Major surgical complications after pancreaticoduodenectomy are associated with worse long-term survival in pancreatic cancer. This effect is independent of the receipt of adjuvant treatment.
Databáze: MEDLINE
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