Preoperative radiographic measurements can predict postoperative pancreatic fistula formation following pancreatoduodenectomy

Abstract

Conclusion: Octogenarians with PDAC-NBT have significant differences in surgical and medical treatment metrics, including lower rates of R0 resection and adjuvant therapy. Despite this, there were no overall differences in perioperative morbidity, mortality, or survival. These data suggest that resection should be pursued in the appropriately selected octogenarian as outcomes are not associated with age-related clinicopathologic factors.Background: Temporary inactivation on the liver transplant waitlist or "Status7" is a transplant center dependent practice. Patients can be inactivated or made Status7 for a variety of reasons including: temporarily too sick, temporarily too well, insurance issues, incomplete work-up, noncompliance and substance abuse, candidate choice, high BMI, and because they cannot be contacted. The criteria to inactivate patients is dependent on individual centers. While Status7, patients are not eligible for liver transplantation. Outcomes of patients following Status7 have not been reported. Methods: All patients removed from a single center's waitlist from 2005e2016 were retrospectively reviewed. Patients were removed from the waitlist and transplanted or removed prior to transplant. Data collected included: demographic factors, reason for temporary inactivation and waitlist removal, number of times and length of time of inactivation on the waitlist, MELD score, and organ and patient survival after transplant. Univariate and survival analyses were performed. Results: Of 1567 patients removed (1075 transplanted; 492 not-transplanted), 31.0% were Status7 at least once. Of the Status7 patients, only 25.1% (n = 122) were transplanted, whereas 88.2% (n = 953) patients never made Status7 were transplanted (p 0.09). Overall, a higher proportion of women than men were not transplanted (36.5% vs 28.5%) (p = 0.002). However, a similar proportion of women and men were Status7 at least once (32.4% vs 29.9%) for similar reasons (52.6% vs 51.3% "too sick"). A significantly lower proportion of women were transplanted after Status7 (17.7% vs. 29.6%) (p = 0.004) (Table). Conclusion: Overall, a history of being Status7 was associated with a higher likelihood of being removed from the waitlist without transplantation. However, patients who were transplanted after a history of temporary inactivation for being "too sick", there was similar patient and organ survival. Women were statistically less likely to ultimately reach transplant despite a similar proportion women and men being made Status7 while on the waitlist. Women were significantly less likely to be transplanted after an episode of temporary inactivation on the waitlist. Investigation is needed to identify why less women recover from temporary inactivation than men.