Journal of Gastrointestinal Surgery

, Volume 18, Issue 1, pp 146–156

Morbidity and Mortality after Pancreaticoduodenectomy in Patients with Borderline Resectable Type C Clinical Classification

  • Ching-Wei D. Tzeng
  • Matthew H. G. Katz
  • Jason B. Fleming
  • Jeffrey E. Lee
  • Peter W. T. Pisters
  • Holly M. Holmes
  • Gauri R. Varadhachary
  • Robert A. Wolff
  • James L. Abbruzzese
  • Jean-Nicolas Vauthey
  • Thomas A. Aloia
2013 SSAT Plenary Presentation

Abstract

Background

We previously described the clinical classification of patients with resectable pancreatic tumor anatomy but marginal performance status (PS) or reversible comorbidities as “borderline resectable type C” (BR-C). This study was designed to analyze the incidence and risk factors for post-pancreaticoduodenectomy (PD) morbidity/mortality in a multi-institutional cohort of BR-C patients.

Methods

Elective PDs were evaluated from the 2005-10 ACS-NSQIP database. BR-C was defined as age ≥ 80, poor PS, weight loss > 10 %, pulmonary disease, recent myocardial infarction/angina, stroke history, and/or preoperative sepsis. Variables associated with 30-day postoperative major complications (PMC) and mortality were analyzed.

Results

A total of 3,033/8,266 (36.7 %) patients were BR-C. BR-C patients were more likely to suffer PMC (31.3 vs. 26.2 %) and mortality (4.1 vs. 2.3 %). BR-C patients with PMC suffered 50 % higher mortality versus non-BR-C patients with PMC (11.5 vs. 7.7 %) (all p < 0.001). For BR-C patients, multivariate analysis identified the following risk factors for PMC or mortality: albumin < 3.5 g/dL, dyspnea, preoperative sepsis, age ≥ 80, poor PS, anesthesia score ≥ 4, and intraoperative transfusion ≥ 4 units.

Conclusions

Nationwide, one third of patients undergoing PD are medically borderline. These BR-C patients are at higher risk for and less able to be rescued from PMC. Surgeons should identify and optimize comorbidities and utilize prehabilitation to address functional deficits before elective PD.

Keywords

Pancreatic cancer Surgery Complications Outcomes Prehabilitation Frailty Conditioning Comorbidities Optimization Elderly Nutrition Neoadjuvant therapy 

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Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Ching-Wei D. Tzeng
    • 1
  • Matthew H. G. Katz
    • 1
  • Jason B. Fleming
    • 1
  • Jeffrey E. Lee
    • 1
  • Peter W. T. Pisters
    • 1
  • Holly M. Holmes
    • 2
  • Gauri R. Varadhachary
    • 3
  • Robert A. Wolff
    • 3
  • James L. Abbruzzese
    • 3
  • Jean-Nicolas Vauthey
    • 1
  • Thomas A. Aloia
    • 1
  1. 1.Department of Surgical Oncology, Unit 1484The University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of General Internal MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of GI Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA

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