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Major Complications Independently Increase Long-Term Mortality After Pancreatoduodenectomy for Cancer

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Postoperative major morbidity has been associated with worse survival gastrointestinal tumors. This association remains controversial in pancreatic cancer (PC). We analyzed whether major complications after surgical resection affect long-term survival.

Methods

Records of all PC patients resected from 2007 to 2015 were reviewed. Major morbidity was defined as any grade-3 or higher 30-day complications, per the Clavien-Dindo Classification. Patients who died within 90 days after surgery were excluded from survival analysis.

Results

Of 616 patients, 81.7% underwent pancreatoduodenectomy (PD) and 18.3% distal pancreatectomy (DP). Major complications occurred in 19.1% after PD and 15.9% after DP. In patients who survived > 90 days, the likelihood of receiving adjuvant treatment was 43.9% if major complications had occurred, vs. 68.5% if not (p < 0.001), and those who received it started the treatment median 10 days later compared with uncomplicated patients (median 60 days (50–72) vs. 50 days (41–61), p = 0.001). By univariate analysis, in addition to the conventional pathology-related prognostic determinants and the receipt of adjuvant treatment, major complications worsened long-term survival after PD (median OS 26 months vs. 15, p = 0.008). A difference was also seen after DP, but it did not reach statistical significance, likely related to the small sample size (median OS 33 months vs. 18, p = 0.189). At multivariate analysis for PD, major postoperative complications remained independently associated with worse survival [HR 1.37, 95%CI (1.01–1.86)].

Conclusions

Major surgical complications after pancreaticoduodenectomy are associated with worse long-term survival in pancreatic cancer. This effect is independent of the receipt of adjuvant treatment.

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Authors and Affiliations

  1. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman ST, Boston, MA, 02114-02115, USA

    M. Sandini, C. R. Ferrone, M. Qadan, A. L. Warshaw, K. D. Lillemoe & Carlos Fernández-del Castillo

  2. Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    K. J. Ruscic & M. Eikermann

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  1. M. Sandini
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  7. K. D. Lillemoe
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  8. Carlos Fernández-del Castillo
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Contributions

Drs. Sandini, Ruscic, Ferrone, Qadan, Eikermann, Warshaw, Lillemoe, and Fernández provided substantial contributions to the conception and design of the work, or the acquisition, analysis, or interpretation of data for the work.

Dr. Sandini and Dr. Fernández drafted the work, Drs. Qadan, Warshaw, and Lillemoe revised it critically for important intellectual content. All authors gave final approval of the version to be published. All authors give their agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Carlos Fernández-del Castillo.

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Sandini, M., Ruscic, K.J., Ferrone, C.R. et al. Major Complications Independently Increase Long-Term Mortality After Pancreatoduodenectomy for Cancer. J Gastrointest Surg 23, 1984–1990 (2019). https://doi.org/10.1007/s11605-018-3939-y

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