Postoperative complications and overall survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Abstract

INTRODUCTION Pancreaticoduodenectomy (PD) performed for pancreatic ductal adenocarcinoma (PDA) has a postoperative morbidity of 40–50%. In this study, we analyzed the impact of high grade complications after PD for PDA on overall survival. METHODS 596 patients that underwent PD for PDA between 2001–2009 were identified from a prospective database. Complications were defined and graded (1–5) as per our Institutional Surgical Secondary Events Program. High grade complications were defined as ≥ grade 3. Postoperative mortality (≤ 90 days) was excluded. Univariate and multivariate analyses were performed to identify factors associated with overall survival. RESULTS Median survival was 24 months. Overall complication rate was 51% (301/596). Low grade complications were recorded in 266 patients (45%) and high grade complications in 22% (n= 129). Our 90 day mortality was 3.7% (n= 22). Anastomotic fistula/ leak/abscess rate was 14% (n= 82). Multivariate Cox-Regression analysis identified node positivity, estimated blood loss (EBL) > 600 ml, length of stay (LOS) > 10 days, margin positivity and vascular procedures as predictors of decreased overall survival (p < 0.05). High grade complications were not associated with overall survival (p = 0.948). CONCLUSION In this study, the occurrence of high grade postoperative complications was not associated with overall survival.

Systematic Review of Resection Rates and Clinical Outcomes After FOLFIRINOX-Based Treatment in Patients with Locally Advanced Pancreatic Cancer

“…As expected, the overall R0 resection rates reported in our review (70–77 %) are slightly lower, as reported by two recent studies (84–92 %) on borderline resectable disease 24,25. Surgical outcomes post-resection seem comparable with outcomes in upfront resectable patients, although still based on immature data 26–28…”

Systematic review and meta-analysis of robotic versus open pancreaticoduodenectomy

“…Although the mortality of PD is less than 5%, the morbidity is still approximately 40% [31]. RPD is expected to decrease these complications.…”

GLUT-1 Expression as an Independent Predictor of Outcome in Patients with R1 Pancreatic Ductal Adenocarcinoma

“…In addition, R1 status has a stronger association with survival time than IMP3 or Ki-67 expression. Recently, Kato et al 11 and other investigators found a signi cant association between prognosis and R0 versus R1 disease 21,22 ; however, a multi-institutional study conducted in Japan found no association 23 . Our ndings imply that GLUT-1 expression depends upon the microscopic existence of residual tumors, or R1 disease.…”