Preoperative Predictors for 90-Day Mortality after Pancreaticoduodenectomy in Patients with Adenocarcinoma of the Ampulla of Vater: A Single-Centre Retrospective Cohort Study

Abstract

Background. The standard treatment for ampullary adenocarcinoma is pancreaticoduodenectomy. Identification of preoperative risk factors might help the clinician to select patients fit for resection and potentially decrease morbidity and mortality after PD. We conducted a cohort study to determine the preoperative factors related to 90-day severe morbidity and mortality after PD. Methods. We conducted a retrospective cohort study in patients with a diagnosis of ampullary adenocarcinoma who underwent an open PD between January 2010 and December 2019 at our tertiary centre. Results. Independent preoperative predictors of mortality were the albumin-bilirubin (ALBI) grade 3 (OR: 21.7; CI 95: 2.1–226.9; p = 0.01 ) and the estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m2 (OR: 17.7; CI 95: 1.8–172.6; p = 0.013 ). The eGFR <90 mL/min/1.73 m2 (OR = 6.6; CI 95: 1.9–23.4; p = 0.003 ) and prothrombin time (OR = 1.5; CI 95; 1.1–2.1; p = 0.005 ) were independent predictors for severe morbidity. Conclusion. These findings suggest that baseline renal function measured by the eGFR and liver function categorized with the ALBI grading are predictors of severe morbidity and mortality. Thus, they should be considered when selecting patients for PD or the use of neoadjuvant treatments. Further research is warranted.

Survival after curative pancreaticoduodenectomy for ampullary adenocarcinoma in a South American population: A retrospective cohort study

“…There are some limitations to recognize in the present study. Our primary AAC patient population displayed a high perioperative mortality rate (10 patients were excluded from this study), which we addressed and analysed previously[ 28 ]. We consider this a very important drawback, in addition to the retrospective design of the study.…”

“…Our surgical approach has been described previously[ 28 ]. In brief, the procedure was carried out using level 2 mesopancreas resection[ 29 ], and the pancreatic stump was managed using Blumgart, duct-to-mucosa, or modified dunking (at the discretion of the surgeon).…”

The ALBI score: From liver function in patients with HCC to a general measure of liver function

“…For example, ALBI has been shown to be prognostic in cancers other than HCC, including pancreatic, colon and gastric cancer, intrahepatic cholangiocarcinoma, extrahepatic bile duct cancer, and even brain cancer (glioma and medulloblastoma). [114] , [115] , [116] , [117] , [118] , [119] , [120] , [121] , [122] , [123] , [124] , [125] , [126] , [127] , [128] , [129] , [130] , [131] , [132] , [133] , [134] , [135] , [136] ALBI is likely to be reflective of liver dysfunction in patients undergoing hepatic resection for intrahepatic tumours, such as intrahepatic cholangiocarcinoma or metastatic liver tumours, and tolerance for those undergoing systemic therapy, including chemotherapies, molecular-targeted drugs and immune checkpoint inhibitors. 118 , 123 , [126] , [127] , [128] , 131 , 133 , 134 Although most authors have attempted to link the association of ALBI with a particular cancer to liver function, we should consider whether its association with mortality is actually through some aspect of liver dysfunction or whether it simply reflects the prognostic power of serum albumin and bilirubin levels, independent of liver function.…”

“… Fernandez-Placencia et al. 120 Retrospective 101 Ampullary of Vater cancer ALBI grade and eGFR were predictors of mortality after pancreaticoduodenectomy. Imamura et al.…”

Preoperative chronic kidney disease and complications after pancreatoduodenectomy: a retrospective cohort study

“…Risk stratification according to predetermined predictors of adverse outcomes remains the key to promptly applying possible mitigation strategies. Evidence suggests that patients with a reduced preoperative kidney function are at higher risk of adverse complications following pancreatoduodenectomy 14,15 . The aim of this study was to explore the relationship between preoperative CKD and major postoperative complications in patients undergoing pancreatoduodenectomy at a high‐volume, tertiary referral centre.…”