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A High Abdominal Aortic Calcification Score on CT is a Risk Factor for Postoperative Pancreatic Fistula in Elderly Patients Undergoing Pancreaticoduodenectomy

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Abstract

Background

To evaluate the clinical significance of a CT-based evaluation of abdominal aortic calcification (AAC) in the postoperative outcomes after pancreaticoduodenectomy (PD) in elderly patients.

Methods

Patients 70 years of age and older who were randomly assigned to Group A were compared with those younger than 70 who were assigned to Group B in terms of preoperative and intraoperative variables and postoperative outcomes. We compared the patients with clinically relevant postoperative pancreatic fistula (CR-POPF) (Group C) to those without CR-POPF (Group D), and especially Group A. We also compared the patients with CR-POPF (Group E) to those without CR-POPF (Group E) to clarify the risk factors for POPF, in each of the analyses. The AAC score was determined using the methods of Agatston et al.

Results

Group A more often had frequent atherosclerosis-related comorbidities (62.2%), low serum albumin (55.9%), and a high AAC score (66.1%). There were no significant differences in the postoperative variables. The comparisons between Groups C and D identified four independent risk factors for CR-POPF: BMI ≥ 25 (OR 8.54, 95% CI 3.15–23.1), male gender (OR 3.17, 95% CI 1.28–7.85), soft pancreatic parenchyma (OR 3.43, 95% CI 1.34–8.81), and the absence of MPD dilatation (OR 5.70, 95% CI 2.13–15.3). Comparisons between Groups E and F identified two independent risk factors for CR-POPF: BMI ≥ 25 (OR 29.4, 95% CI 5.77–150) and a high ACC score (OR 10.8, 95% CI 2.08–56.6).

Conclusions

We demonstrated, for the first time, that a high AAC score is a risk factor of CR-POPF in elderly patients who underwent PD.

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References

  1. World population ageing. United Nation: Department of Economic and Social Affairs population Division. http://www.un.org/esa/population/

  2. Beltrame V, Gruppo M, Pastorelli D et al (2015) Outcome of pancreaticoduodenectomy in octogenarians: single institution’s experience and review of the literature. J Visc Surg 152:279–284

    Article  CAS  PubMed  Google Scholar 

  3. Turrini O, Paye F, Bachellier P et al (2013) Pancreatectomy for adenocarcinoma in elderly patients: postoperative outcomes and long term results: a study of the French Surgical Association. Eur J Surg Oncol 39:171–178

    Article  CAS  PubMed  Google Scholar 

  4. Lee MK, DiNorcia J, Reavey PL et al (2010) Pancreaticoduodenectomy can be performed safely in patients aged 80 years and older. J Gastrointest Surg 14:1838–1846

    Article  PubMed  Google Scholar 

  5. Balyaev O, Herzog T, Kaya G et al (2013) Pancreatic surgery in the very old: face to face with a challenge of the near future. World J Surg 37:1013–1020. doi:10.1007/s00268-013-1944-6

    Article  Google Scholar 

  6. Oguro S, Shimada K, Kishi Y et al (2013) Perioperative and long-term outcomes after pancreaticoduodenectomy in elderly patients 80 years of age and older. Langenbecks Arch Surg 398:531–538

    Article  PubMed  Google Scholar 

  7. Dale W, Hemmerich J, Kamm A et al (2014) Geriatric assessment improves prediction of surgical outcomes in older adults undergoing pancreaticoduodenectomy: a prospective cohort study. Ann Surg 259:960–965

    Article  PubMed  Google Scholar 

  8. Renz BW, Khalil PN, Mikhailov M et al (2016) Pancreaticoduodenectomy for adenocarcinoma of the pancreatic head is justified in elderly patients: a retrospective cohort study. Int J Surg 28:118–125

    Article  PubMed  Google Scholar 

  9. Sulpice L, Rayar M, D’Halluin PN et al (2012) Impact of age over 75 years on outcomes after pancreaticoduodenectomy. J Surg Res 178:181–187

    Article  PubMed  Google Scholar 

  10. Kow AW, Sadayan NA, Ernest A et al (2012) Is pancreaticoduodenectomy justified in elderly patients? Surgeon 10:128–136

    Article  CAS  PubMed  Google Scholar 

  11. El Nakeeb A, Atef E, El Hanafy E et al (2016) Outcomes of pancreaticoduodenectomy in elderly patients. Hepatobiliary Pancreat Dis Int 15:419–427

    Article  PubMed  Google Scholar 

  12. Makary MA, Winter JM, Cameron JL et al (2006) Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg 10:347–356

    Article  PubMed  Google Scholar 

  13. Butturini G, Daskalaki D, Molinari E et al (2008) Pancreatic fistula: definition and current problems. J Hepatobiliary Pancreat Surg 15:247–251

    Article  PubMed  Google Scholar 

  14. Lin JW, Cameron JL, Yeo CJ et al (2004) Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula. J Gastrointest Surg 8:951–959

    Article  PubMed  Google Scholar 

  15. Lermite E, Pessaux P, Brehant O et al (2007) Risk factors of pancreatic fistula and delayed gastric emptying after pancreaticoduodenectomy with pancreaticogastrostomy. J Am Coll Surg 204:588–596

    Article  PubMed  Google Scholar 

  16. Zweig BM, Sheth M, Simpson S et al (2012) Association of abdominal aortic calcium with coronary artery calcium and obstructive coronary artery disease: a pilot study. Int J Cardiovasc Imaging 28:399–404

    Article  PubMed  Google Scholar 

  17. Chuang ML, Massaro JM, Levitzky YS et al (2012) Prevalence and distribution of abdominal aortic calcium by gender and age group in a community-based cohort (from the Framingham Heart Study). Am J Cardiol 110:891–896

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Agatston AS, Janowitz WR, Hildner FJ et al (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832

    Article  CAS  PubMed  Google Scholar 

  19. An C, Lee HJ, Lee HS et al (2014) CT-based abdominal aortic calcification score as a surrogate marker for predicting the presence of asymptomatic coronary artery disease. Eur Radiol 24:2491–2498

    Article  PubMed  Google Scholar 

  20. Noda H, Kamiyama H, Kato T et al (2012) Risk factor for pancreatic fistula after pancreaticoduodenectomy performed by a surgeon during a learning curve: analysis of a single surgeon’s experiences of 100 consecutive patients. Hepatogastroenterology 59:1990–1993

    Article  PubMed  Google Scholar 

  21. Noda H, Kamiyama H, Kato T et al (2012) Factors influencing improved patient outcomes after pancreaticoduodenectomy—a single institute experience of 209 consecutive patients in a decade. Hepatogastroenterology 59:2310–2313

    Article  PubMed  Google Scholar 

  22. Watanabe F, Noda H, Kamiyama H et al (2012) Risk factors for intra-abdominal infection after pancreaticoduodenectomy—a retrospective analysis to evaluate the significance of preoperative biliary drainage and postoperative pancreatic fistula. Hepatogastroenterology 59:1270–1273

    PubMed  Google Scholar 

  23. Kakizawa N, Noda H, Watanabe F et al (2014) Instruction of expert surgeon secures favorable outcomes after standard pancreaticoduodenectomy performed by less experienced surgeons. Hepatogastroenterology 61:203–207

    PubMed  Google Scholar 

  24. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  Google Scholar 

  26. Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768

    Article  PubMed  Google Scholar 

  27. Riall TS, Sheffield KM, Kuo YF et al (2011) Resection benefits older adults with locoregional pancreatic cancer despite greater short-term morbidity and mortality. J Am Geriatr Soc 59:647–654

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48:452–458

    Article  CAS  PubMed  Google Scholar 

  29. Gouma DJ, van Geenen RC, van Gulik TM et al (2000) Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg 232:786–795

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. DeOliveira ML, Winter JM, Schafer M et al (2006) Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 244:931–937

    Article  PubMed  PubMed Central  Google Scholar 

  31. Riall TS, Reddy DM, Nealon WH et al (2008) The effect of age on short-term outcomes after pancreatic resection: a population-based study. Ann Surg 248:459–467

    PubMed  PubMed Central  Google Scholar 

  32. Sugimoto M, Takahashi S, Gotohda N et al (2013) Schematic pancreatic configuration: a risk assessment for postoperative pancreatic fistula after pancreaticoduodenectomy. J Gastrointest Surg. 17:1744–1751

    Article  PubMed  Google Scholar 

  33. Motoi F, Egawa S, Rikiyama T et al (2012) Randomized clinical trial of external stent drainage of the pancreatic duct to reduce postoperative pancreatic fistula after pancreaticojejunostomy. Br J Surg 99:524–531

    Article  CAS  PubMed  Google Scholar 

  34. Mathur A, Pitt HA, Marine M et al (2007) Fatty pancreas: a factor in postoperative pancreatic fistula. Ann Surg 246:1058–1064

    Article  PubMed  Google Scholar 

  35. Hiyoshi M, Chijiiwa K, Fujii Y et al (2013) Usefulness of drain amylase, serum C-reactive protein levels and body temperature to predict postoperative pancreatic fistula after pancreaticoduodenectomy. World J Surg 37:2436–2442. doi:10.1007/s00268-013-2149-8

    Article  PubMed  Google Scholar 

  36. Fujii T, Kanda M, Nagai S et al (2015) Excess weight adversely influences treatment length of postoperative pancreatic fistula: a retrospective study of 900 patients. Pancreas 44:971–976

    Article  PubMed  Google Scholar 

  37. Fang CH, Chen QS, Yang J et al (2016) Body mass index and stump morphology predict an increased incidence of pancreatic fistula after pancreaticoduodenectomy. World J Surg 40:1467–1476. doi:10.1007/s00268-016-3413-5

    Article  PubMed  Google Scholar 

  38. Gaujoux S, Cortes A, Couvelard A et al (2010) Fatty pancreas and increased body mass index are risk factors of pancreatic fistula after pancreaticoduodenectomy. Surgery 148:15–23

    Article  PubMed  Google Scholar 

  39. Strasberg SM, McNevin MS (1998) Results of a technique of pancreaticojejunostomy that optimizes blood supply to the pancreas. J Am Coll Surg 187:591–596

    Article  CAS  PubMed  Google Scholar 

  40. Strasberg SM, Drebin JA, Mokadam NA et al (2002) Prospective trial of a blood supply-based technique of pancreaticojejunostomy: effect on anastomotic failure in the Whipple procedure. J Am Coll Surg 194:746–758

    Article  PubMed  Google Scholar 

  41. Sugimoto M, Takahashi S, Kobayashi T et al (2015) Pancreatic perfusion data and post-pancreaticoduodenectomy outcomes. J Surg Res 194:441–449

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan

    Nao Kakizawa, Hiroshi Noda, Fumiaki Watanabe, Kosuke Ichida, Koichi Suzuki & Toshiki Rikiyama

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  1. Nao Kakizawa
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  2. Hiroshi Noda
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  3. Fumiaki Watanabe
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  4. Kosuke Ichida
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  6. Toshiki Rikiyama
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Correspondence to Hiroshi Noda.

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Kakizawa, N., Noda, H., Watanabe, F. et al. A High Abdominal Aortic Calcification Score on CT is a Risk Factor for Postoperative Pancreatic Fistula in Elderly Patients Undergoing Pancreaticoduodenectomy. World J Surg 42, 1129–1137 (2018). https://doi.org/10.1007/s00268-017-4240-z

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