Long-Term Surgical Complications After Pancreatoduodenectomy: Incidence, Outcomes, and Risk Factors.

Autor: Brown JA; School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA., Zenati MS; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Simmons RL; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Al Abbas AI; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Chopra A; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Smith K; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Lee KKW; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Hogg ME; Department of Surgery, Northshore University Health System, Evanston, IL, USA., Zeh HJ; Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA., Paniccia A; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Zureikat AH; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. zureikatah@upmc.edu.; Division of GI Surgical Oncology, UPMC Pancreatic Cancer Center, University of Pittsburgh Medical Center, 5150 Center Ave., Suite 421, UPMC Cancer Pavilion, Pittsburgh, PA, 15232, USA. zureikatah@upmc.edu.
Jazyk: angličtina
Zdroj: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2020 Jul; Vol. 24 (7), pp. 1581-1589. Date of Electronic Publication: 2020 May 14.
DOI: 10.1007/s11605-020-04641-3
Abstrakt: Background: Long-term complications following pancreatoduodenectomy (PD) can significantly impact quality of life and healthcare utilization. Most reports focus on short-term (within 90 days) PD outcomes; however, the incidence and risk factors for long-term complications (> 90 days) remain to be evaluated. We sought to identify the incidence, outcomes, and risk factors for long-term complications post-PD.
Methods: All PD survivors between 2010 and 2017 were identified from a single-institutional database. Long-term complications (> 90 days post-PD and not resulting from cancer recurrence), including biliary stricture, cholangitis, pancreatitis, peptic ulcer, small bowel obstruction, and incisional hernia, were identified. Logistic regression was used to identify perioperative predictors of long-term complications.
Results: Of 906 PDs, 628 long-term survivors met criteria for analysis (mean age of 65.3 years, 47% female). Median follow-up and overall survival were 51.1 months (95% CI 47.6, 55.7) and 68.5 months (95% CI 57.9, 81.4), respectively. A total of 198 (31.5%) experienced at least one long-term complication. Complications included incisional hernia (17.7%), biliary stricture or cholangitis (8.0%), pancreatitis (5.7%), small bowel obstruction (4.3%), and peptic ulcer (3.2%). In total, 108 (17.2%) of the complications required an intervention, nearly half of which were surgical. On multivariable analysis, several predictors of long-term complications were identified: obesity (BMI ≥ 30 kg/m 2 ), postoperative wound infection, prolonged index length of stay, readmission (< 90 days), operative approach (open vs. robotic), and pylorus-preservation.
Conclusion: Long-term complications occur in nearly a third of PDs and nearly one-fifth of all PDs require re-intervention. Several modifiable predictors of long-term complications were identified.
Databáze: MEDLINE
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