Complications and survival associated with operative procedures in patients with unresectable pancreatic head adenocarcinoma

Spanheimer, Philip M.; Cyr, Anthony R.; Liao, Junlin; Johlin, Frederick C.; Hoshi, Hisakazu; Howe, James R.; Mezhir, James J.

doi:10.1002/jso.23560

Cited by 33 publications

(34 citation statements)

References 33 publications

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“…7,20 To explain the observed increased mortality in older patients undergoing major surgery, several studies have evaluated the impact of postoperative complications on patient survival. 6,20,21 A population based study by Finlayson et al demonstrated higher complication rates in older patients undergoing pancreatic resection for cancer. 8 Likewise, in a retrospective cohort study by Haigh et al using NSQIP data, age > 70 years was found to be an independent prognostic factor for increased postoperative complications following pancreaticoduodenectomy.…”

Section: Discussionmentioning

confidence: 99%

“…4–6 Two recent, large, population based studies demonstrated that advanced age was independently associated with longer lengths of stay and higher mortality rates following pancreatic surgery. 7,8 Previous studies have focused solely on mortality following pancreatectomy in older patients 7,9–11 or failure to rescue for all patients undergoing pancreatectomy.…”

Section: Introductionmentioning

confidence: 99%

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Relative Contributions of Complications and Failure to Rescue on Mortality in Older Patients Undergoing Pancreatectomy

et al. 2016

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STRUCTURED ABSTRACT OBJECTIVE AND SUMMARY BACKGROUND DATA For pancreatectomy patients, mortality increases with increasing age. Our study evaluated the relative contribution of overall postoperative complications and failure to rescue rates on the observed increased mortality in older patients undergoing pancreatic resection at specialized centers. METHODS We identified 2,694 patients who underwent pancreatic resection from the ACS-NSQIP Pancreatectomy Demonstration Project at 37 high volume centers. Overall morbidity and in-hospital mortality were determined in patients <80 (N=2,496) and ≥80 (N=198) years old. Failure to rescue was the number of deaths in patients with complications divided by the total number of patients with postoperative complications. RESULTS No significant differences were observed between patients <80 and ≥80 in the rates of overall complications (41.4% vs. 39.4%, p=0.58). In-hospital mortality increased in patients ≥80 compared to patients <80 (3.0% vs. 1.1%, p=0.02). Failure to rescue rates were higher in patients ≥80 (7.7% vs. 2.7%, p=0.01). Across 37 high volume centers, unadjusted complication rates ranged from 25.0%–72.2% and failure to rescue rates ranged from 0.0%–25.0%. Among patients with postoperative complications, comorbidities associated with failure to rescue were ascites, COPD, and diabetes. Complications associated with failure to rescue included acute renal failure, septic shock, and postoperative pulmonary complications. CONCLUSION In experienced hands, the rates of complications after pancreatectomy in patients ≥80 compared to patients <80 were similar. However, when complications occurred, older patients were more likely to die. Interventions to identify and aggressively treat complications are necessary to decrease mortality in vulnerable older patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Relative Contributions of Complications and Failure to Rescue on Mortality in Older Patients Undergoing Pancreatectomy

et al. 2016

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“…In comparison, if patients were not symptomatic but had evidence of impending obstruction, only about 40% had a poor outcome. 21 If endoscopic expertise is available, stenting is often preferable for gastric obstructions, although this is heavily dependent on operator ability. Stents for gastric outlet obstruction are noted to be quite successful (approximately 90%) with rare complications.…”

Section: Gastric Outlet Obstructionmentioning

confidence: 99%

Palliative Surgery: Incidence and Outcomes

Sun¹,

Krouse²

2014

Seminars in Oncology Nursing

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“…Surgical biliary decompression had been the mainstay of treatment for biliary decompression in such patients. However, it had significantly high morbidity and mortality in the postoperative period 5–7. Percutaneous transhepatic biliary drainage (PTBD) has a more favorable adverse events profile than surgical decompression but is associated with complications like fistula formation, repeat intervention, recurrent infection, and needs a long-term external catheter drainage, thereby leading to poor quality of life 8–10.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage after failed endoscopic retrograde cholangiopancreatography: a meta-analysis

Baniya¹,

Upadhaya²,

Madala³

et al. 2017

CEG

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The failure rate of endoscopic retrograde cholangiopancreatography for biliary cannulation is approximately 6%–7% in cases of obstructive jaundice. Percutaneous transhepatic biliary drainage (PTBD) is the procedure of choice in such cases. Endoscopic ultrasound-guided biliary drainage (EGBD) is a novel technique that allows biliary drainage by echoendoscopy and fluoroscopy using a stent from the biliary tree to the gastrointestinal tract. Information in PubMed, Scopus, clinicaltrials.gov and Cochrane review were analyzed to obtain studies comparing EGBD and PTBD. Six studies fulfilled the inclusion criteria. Technical (odds ratio (OR): 0.34; confidence interval (CI) 0.10–1.14; p=0.05) and clinical (OR: 1.48; CI 0.46–4.79; p=0.51) success rates were not statistically significant between the EGBD and PTBD groups. Mild adverse events were nonsignificantly different (OR: 0.36; CI 0.10–1.24; p=0.11) but not the moderate-to-severe adverse events (OR: 0.16; CI 0.08–0.32; p≤0.00001) and total adverse events (OR: 0.34; CI 0.20–0.59; p≤0.0001). EGBD is equally effective but safer than PTBD.

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Complications and survival associated with operative procedures in patients with unresectable pancreatic head adenocarcinoma

Cited by 33 publications

References 33 publications

Relative Contributions of Complications and Failure to Rescue on Mortality in Older Patients Undergoing Pancreatectomy

Relative Contributions of Complications and Failure to Rescue on Mortality in Older Patients Undergoing Pancreatectomy

Palliative Surgery: Incidence and Outcomes

Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage after failed endoscopic retrograde cholangiopancreatography: a meta-analysis

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