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Short-term surgical morbidity and mortality of distal pancreatectomy performed for benign versus malignant diseases: a NSQIP analysis

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Abstract

Background/aim

Distal pancreatectomy (DP) accounts for 25% of all pancreatic resections. Complications following DP occur in around 40% of the cases. Our aim is to analyze short-term surgical outcomes of DP based on whether the indication for resection was benign or malignant pathology, as well as the effect of the surgical approach, open versus laparoscopic on morbidity and mortality.

Methods

We studied all patients undergoing DP from the National Surgery Quality Improvement Program (NSQIP) targeted pancreatectomy participant use file from 2014 to 2016. The patients were divided into 2 groups, those who underwent DP for benign diseases (DP-B) and those who underwent DP for malignant diseases (DP-M). We performed multivariate logistic regression to evaluate the association between benign or malignant distal pancreatectomies and 30-day outcomes. We included clinically and/or statistically significant confounders into the models. We also conducted the same analysis in the subgroups of open and laparoscopic DP.

Results

Three thousand five hundred and seventy-nine patients underwent distal pancreatectomy. The most common indication for surgery was malignant disease in 1894 (53%). Thirty-day mortality occurred in 0.4% of DP-B compared to 1.3% DP-M. On multivariate analysis, no significant difference was found in mortality or in the risk of pancreatic fistula between the 2 groups. Bleeding (p = 0.002) and composite morbidity (p = 0.01) were significantly higher in the DP-M group. Among composite morbidities, thromboembolism was significantly associated with DP-M (OR 2.1, p = 0.0004) only when performed with an open approach.

Conclusion

DP-M is associated with a significantly higher risk of post-operative bleeding, thromboembolism, and sepsis compared to DP-B but no significant increase in mortality. When further analyzing the impact of the operative approach on morbidity, there was an increased rate of post-operative thromboembolic in the DP-M group when the surgery was performed in an open manner and this increased risk was no longer statistically significant if the DP-M was performed using a minimally invasive approach.

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Authors and Affiliations

  1. Department of Internal Medicine, Gastroenterology and Hepatology Division, American University of Beirut Medical Center, Beirut, Lebanon

    Fady E. Daniel & Mohammad N. Hosni

  2. Biostatistics Unit, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon

    Hani M. Tamim & Aurelie C. Mailhac

  3. Department of Surgery, American University of Beirut Medical Center, Cairo Street, Hamra 72020, Beirut, Lebanon

    Mohammad J. Khalife, Faek R. Jamali & Walid Faraj

Authors
  1. Fady E. Daniel
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  2. Hani M. Tamim
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  3. Mohammad N. Hosni
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  4. Aurelie C. Mailhac
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  5. Mohammad J. Khalife
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  6. Faek R. Jamali
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All the authors met all 4 criteria as per the ICMJE.

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Correspondence to Faek R. Jamali or Walid Faraj.

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Disclosures

Fady Daniel, Hani Tamim, Mohammad Hosni, Aurelie Mailhac, Mohamad Khalife, Faek Jamali, and Walid Faraj have no conflicts of interest or financial ties to disclose.

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Daniel, F.E., Tamim, H.M., Hosni, M.N. et al. Short-term surgical morbidity and mortality of distal pancreatectomy performed for benign versus malignant diseases: a NSQIP analysis. Surg Endosc 34, 3927–3935 (2020). https://doi.org/10.1007/s00464-019-07163-5

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  • DOI: https://doi.org/10.1007/s00464-019-07163-5

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