Predictive Factors for Complications After Pancreaticoduodenectomy

Background

Knowledge of the risk factors for complications following pancreaticoduodenectomy (PD) is sparse and there is not a consensus regarding the criteria to define the complications. The objective of this study was to determine the predictive risk factors for this surgery using the international study group definition.

Patients and methods

Between October 1999 and September 2005, data from 295 consecutive patients who underwent a PD in the Eastern Hepatobiliary Surgery Hospital were recorded prospectively. Medical records and specific charts from surgical procedures, histopathology reports, and intensive care units were continually scrutinized. Multivariable logistic regression analyses were used to estimate relative risks and their 95% confidence intervals.

Results

Among 295 patients undergoing PD, 103 (34.9%) experienced at least one complication. Operations by low-volume surgeons (<50 PD surgeries across their lifetime) were followed by more abdominal complications (odds ratio [OR] 45.2). End-to-end pancreaticojejunostomy (PJ) resulted in more complications than end-to-side PJ (OR 2.7). Diabetes mellitus, increased estimated blood loss, and soft gland texture significantly increased the risks of abdominal complications. Systemic morbidity (OR 9.9) was the only independent predictive factor for mortality.

Conclusion

High-volume surgeons and end-to-side PJ greatly reduce the risk of abdominal complications in patients undergoing PD. The higher abdominal complications rate in patients with soft gland texture was similar to those found in previous reports. Moreover, PD should be performed with considerable attention in patients with diabetes mellitus.

Key Words: pancreaticoduodenectomy, morbidity, mortality, pancreatic fistula