Annals of Surgical Oncology

, Volume 16, Issue 10, pp 2825–2833

Laparoscopic Left Pancreatectomy: Complication Risk Score Correlates With Morbidity and Risk for Pancreatic Fistula

  • Sharon M. Weber
  • Clifford S. Cho
  • Nipun Merchant
  • Scott Pinchot
  • Robert Rettammel
  • Atilla Nakeeb
  • David Bentrem
  • Alex Parikh
  • Ashley E. Mazo
  • Robert C. G. MartinIII
  • Charles R. Scoggins
  • Syed A. Ahmad
  • Hong Jin Kim
  • Nicholas Hamilton
  • William Hawkins
  • C. Max Schmidt
  • David A. Kooby
Pancreatic Tumors

DOI: 10.1245/s10434-009-0597-z

Cite this article as:
Weber, S.M., Cho, C.S., Merchant, N. et al. Ann Surg Oncol (2009) 16: 2825. doi:10.1245/s10434-009-0597-z

Abstract

Background

Surgeons are performing laparoscopic left pancreatectomy (LLP) with increasing frequency; however, determinants of perioperative outcome after LLP are not well defined. We evaluated factors contributing to morbidity after LLP.

Methods

Records from patients undergoing LLP from 2000 to 2008 from nine academic medical centers were evaluated to assess risk factors for perioperative complications. Extent of pancreatic resection was determined by the length of the gross pancreatic specimen. Complications and pancreatic fistula rates were assessed, and a model was developed to identify those at risk of postoperative adverse events.

Results

Among the 219 LLP cases, indications were cystic neoplasms in 122 (56%), solid neoplasms in 83 (38%), and chronic pancreatitis in 14 (6%). Thirty-day morbidity and mortality were 39% and 0, respectively. Major complications occurred in 11%. Pancreatic fistulae were detected in 23%, with clinically important fistulae (International Study Group on Pancreatic Fistula Definition grade B/C) seen in 10%. On multivariate analysis, only greater estimated blood loss (EBL), higher body mass index (BMI), and longer length of resected pancreas were associated with major complications. A complication risk score consisting of 1 point each for BMI >27, pancreatic specimen length >8 cm, or EBL ≥150 mL predicted an increased risk of complications and pancreatic fistulae.

Conclusions

The risk of major complications after LLP is 11%, with clinically important pancreatic fistulae occurring in 10%. A complication risk score incorporating BMI, extent of pancreatic resection, and EBL correlates with all end points evaluated. The complication risk score should be used when quality outcome measures are evaluated.

Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • Sharon M. Weber
    • 1
  • Clifford S. Cho
    • 1
  • Nipun Merchant
    • 2
  • Scott Pinchot
    • 1
  • Robert Rettammel
    • 1
  • Atilla Nakeeb
    • 3
  • David Bentrem
    • 4
  • Alex Parikh
    • 2
  • Ashley E. Mazo
    • 9
  • Robert C. G. MartinIII
    • 5
  • Charles R. Scoggins
    • 5
  • Syed A. Ahmad
    • 6
  • Hong Jin Kim
    • 7
  • Nicholas Hamilton
    • 8
  • William Hawkins
    • 8
  • C. Max Schmidt
    • 3
  • David A. Kooby
    • 9
  1. 1.Section of Surgical Oncology, Department of Surgery, H4/752 Clinical Science CenterUniversity of Wisconsin HospitalMadisonUSA
  2. 2.Department of SurgeryVanderbilt UniversityNashvilleUSA
  3. 3.Department of SurgeryIndiana UniversityBloomingtonUSA
  4. 4.Department of SurgeryNorthwestern UniversityEvanstonUSA
  5. 5.Department of SurgeryUniversity of LouisvilleLouisvilleUSA
  6. 6.Department of SurgeryUniversity of CincinnatiCincinnatiUSA
  7. 7.Department of SurgeryUniversity of North Carolina–Chapel HillChapel HillUSA
  8. 8.Department of SurgeryWashington UniversitySeattleUSA
  9. 9.Department of SurgeryEmory UniversityAtlantaUSA