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

  • Pancreatic Tumors
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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.

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References

  1. Kooby DA, Gillespie T, Bentrem D, et al. Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg. 2008;248:438–46.

    PubMed  Google Scholar 

  2. Begg CB, Cramer LD, Hoskins WJ, et al. Impact of hospital volume on operative mortality for major cancer surgery. JAMA. 1998;280:1747–51.

    Article  CAS  PubMed  Google Scholar 

  3. Riall TS, Reddy DM, Nealon WH, et al. The effect of age on short-term outcomes after pancreatic resection: a population-based study. Ann Surg. 2008;248:459–67.

    PubMed  Google Scholar 

  4. Riall TS, Nealon WH, Goodwin JS, et al. Outcomes following pancreatic resection: variability among high-volume providers. Surgery. 2008;144:133–40.

    Article  PubMed  Google Scholar 

  5. Rodriguez JR, Madanat MG, Healy BC, et al. Distal pancreatectomy with splenic preservation revisited. Surgery. 2007;141:619–25.

    Article  PubMed  Google Scholar 

  6. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.

    Article  PubMed  Google Scholar 

  7. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  Google Scholar 

  8. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111:518–26.

    CAS  PubMed  Google Scholar 

  9. DeOliveira ML, Winter JM, Schafer M, et al. Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg. 2006;244:931–7.

    Article  PubMed  Google Scholar 

  10. Martin RC, Brennan MF, Jaques DP. Quality of complication reporting in the surgical literature. Ann Surg. 2002;235:803–13.

    Article  PubMed  Google Scholar 

  11. Strasberg SM, Linehan DC, Clavien PA, et al. Proposal for definition and severity grading of pancreatic anastomosis failure and pancreatic occlusion failure. Surgery. 2007;141:420–6.

    Article  PubMed  Google Scholar 

  12. Mullen JT, Davenport DL, Hutter MM, et al. Impact of body mass index on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery. Ann Surg Oncol. 2008;15:2164–72.

    Article  PubMed  Google Scholar 

  13. House MG, Fong Y, Arnaoutakis DJ, et al. Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution. J Gastrointest Surg. 2008;12:270–8.

    Article  PubMed  Google Scholar 

  14. Sledzianowski JF, Duffas JP, Muscari F, et al. Risk factors for mortality and intra-abdominal morbidity after distal pancreatectomy. Surgery. 2005;137:180–5.

    Article  CAS  PubMed  Google Scholar 

  15. Ferrone CR, Warshaw AL, Rattner DW, et al. Pancreatic fistula rates after 462 distal pancreatectomies: staplers do not decrease fistula rates. J Gastrointest Surg. 2008;12:1691–7.

    Article  PubMed  Google Scholar 

  16. Lermite E, Pessaux P, Brehant O, et al. Risk factors of pancreatic fistula and delayed gastric emptying after pancreaticoduodenectomy with pancreaticogastrostomy. J Am Coll Surg. 2007;204:588–96.

    Article  PubMed  Google Scholar 

  17. Vin Y, Sima CS, Getrajdman GI, et al. Management and outcomes of postpancreatectomy fistula, leak, and abscess: results of 908 patients resected at a single institution between 2000 and 2005. J Am Coll Surg. 2008;207:490–8.

    Article  PubMed  Google Scholar 

  18. Bentrem DJ, Yeh JJ, Brennan MF, et al. Predictors of intensive care unit admission and related outcome for patients after pancreaticoduodenectomy. J Gastrointest Surg. 2005;9:1307–12.

    Article  PubMed  Google Scholar 

  19. Lin JW, Cameron JL, Yeo CJ, et al. Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula. J Gastrointest Surg. 2004;8:951–9.

    Article  PubMed  Google Scholar 

  20. Goh BK, Tan YM, Chung YF, et al. Critical appraisal of 232 consecutive distal pancreatectomies with emphasis on risk factors, outcome, and management of the postoperative pancreatic fistula: a 21-year experience at a single institution. Arch Surg. 2008;143:956–65.

    Article  PubMed  Google Scholar 

  21. Mathur A, Pitt HA, Marine M, et al. Fatty pancreas: a factor in postoperative pancreatic fistula. Ann Surg. 2007;246:1058–64.

    Article  PubMed  Google Scholar 

  22. Kim W, Song KY, Lee HJ, et al. The impact of comorbidity on surgical outcomes in laparoscopy-assisted distal gastrectomy: a retrospective analysis of multicenter results. Ann Surg. 2008;248:793–9.

    Article  PubMed  Google Scholar 

  23. Yamada H, Kojima K, Inokuchi M, et al. Effect of obesity on technical feasibility and postoperative outcomes of laparoscopy-assisted distal gastrectomy—comparison with open distal gastrectomy. J Gastrointest Surg. 2008;12:997–1004.

    Article  PubMed  Google Scholar 

  24. Pikarsky AJ, Saida Y, Yamaguchi T, et al. Is obesity a high-risk factor for laparoscopic colorectal surgery? Surg Endosc Other Intervent Tech. 2002;16:855–8.

    CAS  Google Scholar 

  25. Senagore AJ, Delaney CP, Madboulay K, et al. Laparoscopic colectomy in obese and nonobese patients. J Gastrointest Surg. 2003;7:558–61.

    Article  PubMed  Google Scholar 

  26. Strasberg SM, McNevin MS. Results of a technique of pancreaticojejunostomy that optimizes blood supply to the pancreas. J Am Coll Surg. 1998;187:591–6.

    Article  CAS  PubMed  Google Scholar 

  27. Kleeff J, Diener MK, Z’graggen K, et al. Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg. 2007;245:573–82.

    Article  PubMed  Google Scholar 

  28. Pannegeon V, Pessaux P, Sauvanet A, et al. Pancreatic fistula after distal pancreatectomy—predictive risk factors and value of conservative treatment. Arch Surg. 2006;141:1071–6.

    Article  PubMed  Google Scholar 

  29. Fahy BN, Frey CF, Ho HS, et al. Morbidity, mortality, and technical factors of distal pancreatectomy. Am J Surg. 2002;183:237–41.

    Article  PubMed  Google Scholar 

  30. Callery MP, Pratt WB, Vollmer CM Jr. Prevention and management of pancreatic fistula. J Gastrointest Surg. 2009;13:163–73.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Section of Surgical Oncology, Department of Surgery, H4/752 Clinical Science Center, University of Wisconsin Hospital, Madison, WI, USA

    Sharon M. Weber MD, Clifford S. Cho MD, Scott Pinchot MD & Robert Rettammel MA

  2. Department of Surgery, Vanderbilt University, Nashville, TN, USA

    Nipun Merchant MD & Alex Parikh MD

  3. Department of Surgery, Indiana University, Bloomington, IN, USA

    Atilla Nakeeb MD & C. Max Schmidt MD

  4. Department of Surgery, Northwestern University, Evanston, IL, USA

    David Bentrem MD

  5. Department of Surgery, University of Louisville, Louisville, KY, USA

    Robert C. G. Martin III MD, PhD & Charles R. Scoggins MD, MBA

  6. Department of Surgery, University of Cincinnati, Cincinnati, OH, USA

    Syed A. Ahmad MD

  7. Department of Surgery, University of North Carolina–Chapel Hill, Chapel Hill, NC, USA

    Hong Jin Kim MD

  8. Department of Surgery, Washington University, Seattle, WA, USA

    Nicholas Hamilton MD & William Hawkins MD

  9. Department of Surgery, Emory University, Atlanta, GA, USA

    Ashley E. Mazo BS & David A. Kooby MD

Authors
  1. Sharon M. Weber MD
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  2. Clifford S. Cho MD
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  3. Nipun Merchant MD
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  4. Scott Pinchot MD
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  6. Atilla Nakeeb MD
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  7. David Bentrem MD
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  8. Alex Parikh MD
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  9. Ashley E. Mazo BS
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  10. Robert C. G. Martin III MD, PhD
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  11. Charles R. Scoggins MD, MBA
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  12. Syed A. Ahmad MD
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  13. Hong Jin Kim MD
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  14. Nicholas Hamilton MD
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  15. William Hawkins MD
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  16. C. Max Schmidt MD
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  17. David A. Kooby MD
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Corresponding author

Correspondence to Sharon M. Weber MD.

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Weber, S.M., Cho, C.S., Merchant, N. et al. Laparoscopic Left Pancreatectomy: Complication Risk Score Correlates With Morbidity and Risk for Pancreatic Fistula. Ann Surg Oncol 16, 2825–2833 (2009). https://doi.org/10.1245/s10434-009-0597-z

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  • DOI: https://doi.org/10.1245/s10434-009-0597-z

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