| Title: |
Postoperative complications after pancreatoduodenectomy for malignancy: results from the Recurrence After Whipple's (RAW) study |
| Authors: |
Russell, Thomas B; Labib, Peter L; Denson, Jemimah; Streeter, Adam; Ausania, Fabio; Pando, Elizabeth; Roberts, Keith J; Kausar, Ambareen; Mavroeidis, Vasileios K; Marangoni, Gabriele; Thomasset, Sarah C; Frampton, Adam E; Lykoudis, Pavlos; Maglione, Manuel; Alhaboob, Nassir; Bari, Hassaan; Smith, Andrew M; Spalding, Duncan; Srinivasan, Parthi; Davidson, Brian R; Bhogal, Ricky H; Croagh, Daniel; Dominguez, Ismael; Thakkar, Rohan; Gomez, Dhanny; Silva, Michael A; Lapolla, Pierfrancesco; Mingoli, Andrea; Porcu, Alberto; Shah, Nehal S; Hamady, Zaed ZR; Al-Sarrieh, Bilal A; Serrablo, Alejandro; RAW Study Collaborators; Aroori, Somaiah |
| Publisher Information: |
Oxford University Press |
| Publication Year: |
2023 |
| Collection: |
Imperial College London: Spiral |
| Subject Terms: |
Humans; Pancreas; Pancreatic Fistula; Pancreatic Neoplasms; Pancreaticoduodenectomy; Postoperative Complications; Retrospective Studies |
| Subject Geographic: |
England |
| Description: |
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. |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
English |
| Relation: |
BJS Open; https://www.ncbi.nlm.nih.gov/pubmed/38036696; PII: 7456355; BJS Open, 2023, 7 (6); http://hdl.handle.net/10044/1/109901; https://www.dx.doi.org/10.1093/bjsopen/zrad106 |
| DOI: |
10.1093/bjsopen/zrad106 |
| Availability: |
http://hdl.handle.net/10044/1/109901; https://www.ncbi.nlm.nih.gov/pubmed/38036696; https://doi.org/10.1093/bjsopen/zrad106 |
| Rights: |
© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/ licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com ; https://creativecommons.org/licenses/by-nc/4.0/ |
| Accession Number: |
edsbas.83260C58 |
| Database: |
BASE |