Journal of Gastrointestinal Surgery

, Volume 19, Issue 6, pp 1072–1077 | Cite as

Morbidity and Mortality of Pancreaticoduodenectomy for Benign and Premalignant Pancreatic Neoplasms

  • Timothy E. Newhook
  • Damien J. LaPar
  • James M. Lindberg
  • Todd W. Bauer
  • Reid B. Adams
  • Victor M. ZaydfudimEmail author
Original Article



Patients with benign neoplasms of the pancreas are selected for pancreaticoduodenectomy if there is concern for malignant transformation. This study compares outcomes after pancreaticoduodenectomy for patients with premalignant and malignant pancreatic neoplasms.

Study Design

This retrospective cohort study included all patients who underwent pancreaticoduodenectomy for histologically confirmed benign/premalignant pancreatic neoplasms and primary pancreatic malignancy reported to National Surgical Quality Improvement Program (NSQIP) from 2005 to 2011. Patient characteristics, intraoperative and postoperative morbidity and mortality were compared.


A total of 6085 patients underwent pancreaticoduodenectomy: 744 (12.2 %) for benign/premalignant and 5341 (87.8 %) for malignant pancreatic neoplasms. Patients with benign/premalignant neoplasms were more commonly female, had lower American Society of Anesthesiologists (ASA) class, and were less likely to have major comorbidities (all p ≤ 0.003). After resection, patients with benign/premalignant neoplasms were more likely to develop organ space infection (13.4 vs. 8.5 %, p < 0.001) and sepsis (12.2 vs. 9.2 %, p = 0.009). Cardiovascular, pulmonary, renal, and other organ system complications (p = 0.12) as well as 30-day mortality (3.0 vs. 2.0 %, p = 0.128) did not differ.


Organ space infection and sepsis are more common after pancreaticoduodenectomy for benign/premalignant neoplasms. Planned improvements in NSQIP data capture should allow for better measurement of this morbidity. A carefully balanced risk and benefit discussion should precede resection in these patients.


Pancreaticoduodenectomy Pancreatic neoplasms IPMN Pancreatic adenocarcinoma NSQIP 


  1. 1.
    Cameron JL, Riall TS, Coleman J and Belcher KA. One thousand consecutive pancreaticoduodenectomies. Ann Surg 2006;244(1):10-15.CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Fong Y, Gonen M, Rubin D, Radzyner M and Brennan MF. Long-term survival is superior after resection for cancer in high-volume centers. Ann Surg 2005;242(4):540-544.PubMedCentralPubMedGoogle Scholar
  3. 3.
    Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, Sauter PK, Hruban RH, Riall TS, Schulick RD, Choti MA, Lillemoe KD and Yeo CJ. 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg 2006;10(9):1199-1210.CrossRefPubMedGoogle Scholar
  4. 4.
    Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, Hruban RH, Ord SE, Sauter PK, Coleman J, Zahurak ML, Grochow LB and Abrams RA. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 1997;226(3):248-257.CrossRefPubMedCentralPubMedGoogle Scholar
  5. 5.
    Yoshioka R, Yasunaga H, Hasegawa K, Horiguchi H, Fushimi K, Aoki T, Sakamoto Y, Sugawara Y and Kokudo N. Impact of hospital volume on hospital mortality, length of stay and total costs after pancreaticoduodenectomy. Brit J Surg 2014;101(5):523-529.CrossRefPubMedGoogle Scholar
  6. 6.
    Fong ZV, Ferrone CR, Thayer SP, Wargo JA, Sahora K, Seefeld KJ, Warshaw AL, Lillemoe KD, Hutter MM and Fernandez-Del Castillo C. Understanding hospital readmissions after pancreaticoduodenectomy: can we prevent them?: a 10-year contemporary experience with 1,173 patients at the Massachusetts General Hospital. J Gastrointest Surg 2014;18(1):137-144.CrossRefPubMedGoogle Scholar
  7. 7.
    Gawlas I, Sethi M, Winner M, Epelboym I, Lee JL, Schrope BA, Chabot JA and Allendorf JD. Readmission after pancreatic resection is not an appropriate measure of quality. Ann Surg Onc 2013;20(6):1781-1787.CrossRefGoogle Scholar
  8. 8.
    Kastenberg ZJ, Morton JM, Visser BC, Norton JA and Poultsides GA. Hospital readmission after a pancreaticoduodenectomy: an emerging quality metric? HPB (Oxford) 2013;15(2):142-148.CrossRefGoogle Scholar
  9. 9.
    Yermilov I, Bentrem D, Sekeris E, Jain S, Maggard MA, Ko CY and Tomlinson JS. Readmissions following pancreaticoduodenectomy for pancreas cancer: a population-based appraisal. Ann Surg Onc 2009;16(3):554-561.CrossRefGoogle Scholar
  10. 10.
    Orfanidis NT, Loren DE, Santos C, Kennedy EP, Siddiqui AA, Lavu H, Yeo CJ and Kowalski TE. Extended follow-up and outcomes of patients undergoing pancreaticoduodenectomy for nonmalignant disease. J Gastrointest Surg 2012;16(1):80-87.CrossRefPubMedGoogle Scholar
  11. 11.
    Winter JM, Cameron JL, Lillemoe KD, Campbell KA, Chang D, Riall TS, Coleman J, Sauter PK, Canto M, Hruban RH, Schulick RD, Choti MA and Yeo CJ. Periampullary and pancreatic incidentaloma: a single institution's experience with an increasingly common diagnosis. Ann Surg 2006;243(5):673-680.CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Tanaka M, Fernandez-del Castillo C, Adsay V, Chari S, Falconi M, Jang JY, Kimura W, Levy P, Pitman MB, Schmidt CM, Shimizu M, Wolfgang CL, Yamaguchi K, Yamao K and International Association of P. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012;12(3):183-197.CrossRefPubMedGoogle Scholar
  13. 13.
    Lahat G, Ben Haim M, Nachmany I, Sever R, Blachar A, Nakache R and Klausner JM. Pancreatic incidentalomas: high rate of potentially malignant tumors. J Am Coll Surg 2009;209(3):313-319.CrossRefPubMedGoogle Scholar
  14. 14.
    Barens SA, Lillemoe KD, Kaufman HS, Sauter PK, Yeo CJ, Talamini MA, Pitt HA and Cameron JL. Pancreaticoduodenectomy for benign disease. Am J Surg 1996;171(1):131-134.CrossRefPubMedGoogle Scholar
  15. 15.
    American College of Surgeons National Surgical Quality Improvement Program Chapter 4: ACS NSQIP Variables and Definitions. Available at Accessed May 14, 2014.
  16. 16.
    DeOliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ and Clavien PA. Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 2006;244(6):931-937.CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Yeo CJ, Cameron JL, Lillemoe KD, Sohn TA, Campbell KA, Sauter PK, Coleman J, Abrams RA and Hruban RH. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg 2002;236(3):355-366.CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Sohn TA, Yeo CJ, Cameron JL, Hruban RH, Fukushima N, Campbell KA and Lillemoe KD. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg 2004;239(6):788-797.CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Sohn TA, Campbell KA, Pitt HA, Sauter PK, Coleman JA, Lillemo KD, Yeo CJ and Cameron JL. Quality of life and long-term survival after surgery for chronic pancreatitis. J Gastrointest Surg 2000;4(4):355-364.CrossRefPubMedGoogle Scholar
  20. 20.
    Callery MP, Pratt WB, Kent TS, Chaikof EL and Vollmer CM, Jr. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg 2013;216(1):1-14.CrossRefPubMedGoogle Scholar
  21. 21.
    Pratt WB, Callery MP and Vollmer CM, Jr. Risk prediction for development of pancreatic fistula using the ISGPF classification scheme. World J Surg 2008;32(3):419-428.CrossRefPubMedGoogle Scholar
  22. 22.
    Emick DM, Riall TS, Cameron JL, Winter JM, Lillemoe KD, Coleman J, Sauter PK and Yeo CJ. Hospital readmission after pancreaticoduodenectomy. J Gastrointest Surg 2006;10(9):1243-1252.CrossRefPubMedGoogle Scholar
  23. 23.
    Pisters PW, Hudec WA, Hess KR, Lee JE, Vauthey JN, Lahoti S, Raijman I and Evans DB. Effect of preoperative biliary decompression on pancreaticoduodenectomy-associated morbidity in 300 consecutive patients. Ann Surg 2001;234(1):47-55.CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Denbo JW, Orr WS, Zarzaur BL and Behrman SW. Toward defining grade C pancreatic fistula following pancreaticoduodenectomy: incidence, risk factors, management and outcome. HPB (Oxford) 2012;14(9):589-593.CrossRefGoogle Scholar
  25. 25.
    Fuks D, Piessen G, Huet E, Tavernier M, Zerbib P, Michot F, Scotte M, Triboulet JP, Mariette C, Chiche L, Salame E, Segol P, Pruvot FR, Mauvais F, Roman H, Verhaeghe P and Regimbeau JM. Life-threatening postoperative pancreatic fistula (grade C) after pancreaticoduodenectomy: incidence, prognosis, and risk factors. Am J Surg 2009;197(6):702-709.CrossRefPubMedGoogle Scholar
  26. 26.
    Schulick RD. Complications after pancreaticoduodenectomy: intraabdominal abscess. J Hepatobiliary Pancreat Surg 2008;15(3):252-256.CrossRefPubMedGoogle Scholar
  27. 27.
    Sugiura T, Uesaka K, Ohmagari N, Kanemoto H and Mizuno T. Risk factor of surgical site infection after pancreaticoduodenectomy. World J Surg 2012;36(12):2888-2894.CrossRefPubMedGoogle Scholar
  28. 28.
    Schmidt CM, Choi J, Powell ES, Yiannoutsos CT, Zyromski NJ, Nakeeb A, Pitt HA, Wiebke EA, Madura JA and Lillemoe KD. Pancreatic fistula following pancreaticoduodenectomy: clinical predictors and patient outcomes. HPB Surg 2009. doi: 10.1155/2009/404520
  29. 29.
    Parikh JA, Beane JD, Kilbane EM, Milgrom DP, Pitt, HA. Is ACS NSQIP organ space infection a surrogate for pancreatic fistula? J Am Coll Surg 2014;219(6):1111-1116.Google Scholar
  30. 30.
    Parmar AD, Sheffield KM, Vargas GM, Pitt HA, Kilbane EM, Hall BL and Riall TS. Factors associated with delayed gastric emptying after pancreaticoduodenectomy. HPB (Oxford) 2013;15(10):763-772.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2015

Authors and Affiliations

  • Timothy E. Newhook
    • 1
  • Damien J. LaPar
    • 1
  • James M. Lindberg
    • 1
  • Todd W. Bauer
    • 1
  • Reid B. Adams
    • 1
  • Victor M. Zaydfudim
    • 1
    Email author
  1. 1.Section of Hepatobiliary and Pancreatic Surgery, Department of SurgeryUniversity of Virginia Health SystemCharlottesvilleUSA

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