Clinical Outcomes After Total Pancreatectomy: A Prospective Multicenter Pan-European Snapshot Study.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 11 2022
01 11 2022
Historique:
pubmed:
13
11
2020
medline:
12
10
2022
entrez:
12
11
2020
Statut:
ppublish
Résumé
To assess outcomes among patients undergoing total pancreatectomy (TP) including predictors for complications and in-hospital mortality. Current studies on TP mostly originate from high-volume centers and span long time periods and therefore may not reflect daily practice. This prospective pan-European snapshot study included patients who underwent elective (primary or completion) TP in 43 centers in 16 European countries (June 2018-June 2019). Subgroup analysis included cutoff values for annual volume of pancreatoduodenectomies (<60 vs ≥60).Predictors for major complications and in-hospital mortality were assessed in multivariable logistic regression. In total, 277 patients underwent TP, mostly for malignant disease (73%). Major postoperative complications occurred in 70 patients (25%). Median hospital stay was 12 days (IQR 9-18) and 40 patients were readmitted (15%). In-hospital mortality was 5% and 90-day mortality 8%. In the subgroup analysis, in-hospital mortality was lower in patients operated in centers with ≥60 pancreatoduodenectomies compared <60 (4% vs 10%, P = 0.046). In multivariable analysis, annual volume <60 pancreatoduodenectomies (OR 3.78, 95% CI 1.18-12.16, P = 0.026), age (OR 1.07, 95% CI 1.01-1.14, P = 0.046), and estimated blood loss ≥2L (OR 11.89, 95% CI 2.64-53.61, P = 0.001) were associated with in-hospital mortality. ASA ≥3 (OR 2.87, 95% CI 1.56-5.26, P = 0.001) and estimated blood loss ≥2L (OR 3.52, 95% CI 1.25-9.90, P = 0.017) were associated with major complications. This pan-European prospective snapshot study found a 5% inhospital mortality after TP. The identified predictors for mortality, including low-volume centers, age, and increased blood loss, may be used to improve outcomes.
Sections du résumé
OBJECTIVE
To assess outcomes among patients undergoing total pancreatectomy (TP) including predictors for complications and in-hospital mortality.
BACKGROUND
Current studies on TP mostly originate from high-volume centers and span long time periods and therefore may not reflect daily practice.
METHODS
This prospective pan-European snapshot study included patients who underwent elective (primary or completion) TP in 43 centers in 16 European countries (June 2018-June 2019). Subgroup analysis included cutoff values for annual volume of pancreatoduodenectomies (<60 vs ≥60).Predictors for major complications and in-hospital mortality were assessed in multivariable logistic regression.
RESULTS
In total, 277 patients underwent TP, mostly for malignant disease (73%). Major postoperative complications occurred in 70 patients (25%). Median hospital stay was 12 days (IQR 9-18) and 40 patients were readmitted (15%). In-hospital mortality was 5% and 90-day mortality 8%. In the subgroup analysis, in-hospital mortality was lower in patients operated in centers with ≥60 pancreatoduodenectomies compared <60 (4% vs 10%, P = 0.046). In multivariable analysis, annual volume <60 pancreatoduodenectomies (OR 3.78, 95% CI 1.18-12.16, P = 0.026), age (OR 1.07, 95% CI 1.01-1.14, P = 0.046), and estimated blood loss ≥2L (OR 11.89, 95% CI 2.64-53.61, P = 0.001) were associated with in-hospital mortality. ASA ≥3 (OR 2.87, 95% CI 1.56-5.26, P = 0.001) and estimated blood loss ≥2L (OR 3.52, 95% CI 1.25-9.90, P = 0.017) were associated with major complications.
CONCLUSION
This pan-European prospective snapshot study found a 5% inhospital mortality after TP. The identified predictors for mortality, including low-volume centers, age, and increased blood loss, may be used to improve outcomes.
Identifiants
pubmed: 33177356
pii: 00000658-202211000-00064
doi: 10.1097/SLA.0000000000004551
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e536-e543Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Griffin JF, Poruk KE, Wolfgang CL. Is it time to expand the role of total pancreatectomy for IPMN? Dig Surg. 2016;33:335–342.
The European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut. 2018;67:789–804.
Andren-Sandberg A, Ansorge C, Yadav TD. Are there indications for total pancreatectomy in 2016? Dig Surg. 2016;33:329–334.
Scholten L, Latenstein AE, van Eijck CH, et al. Outcome including long-term quality of life after total pancreatectomy (PANORAMA): a nationwide cohort study. Surgery. 2019;166:1017–1026.
Scholten L, Stoop TF, Del Chiaro M, et al. Systematic review of functional outcome and quality of life after total pancreatectomy. Br J Surg. 2019;106:1735–1746.
Petrucciani N, Nigri G, Giannini G, et al. Total pancreatectomy for pancreatic carcinoma: when, why, and what are the outcomes? Results of a systematic review pancreas. Pancreas. 2020;49:175–180.
Pulvirenti A, Pea A, Rezaee N, et al. Perioperative outcomes and long-term quality of life after total pancreatectomy. Br J Surg. 2019;106:1819–1828.
Borstlap WAA, Deijen CL, den Dulk M, et al. Benchmarking recent national practice in rectal cancer treatment with landmark randomized controlled trials. Color Dis. 2017;19:O219–O231.
Bhangu A, Kolias AG, Pinkney T, et al. Surgical research collaboratives in the U.K. Lancet. 2013;382:1091–1092.
Elm E, Von Altman DG, Egger M, et al. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806–808.
Edge SB, Byrd DR, Compton CC, Fritz AG, Greene F, Trotti A, eds. AJCC Cancer Staging Manual. 7th ed., New York: Springer; 2010.
Dindo D, Demartines N, Clavien P-A. Classification of surgical complications. Ann Surg. 2004;240:205–213.
Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142:761–768.
Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142:20–25.
Besselink MG, Rijssen LB, Van Bassi C, et al. Pancreas Definition and classification of chyle leak after pancreatic operation: a consensus statement by the International Study Group on Pancreatic Surgery. Surgery. 2017;161:365–372.
Koch M, Garden OJ, Padbury R, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery. 2011;149:680–688.
van der Geest LGM, van Rijssen LB, Molenaar IQ, et al. Volume-outcome relationships in pancreatoduodenectomy for cancer. HPB (Oxford). 2016;18:317–324.
Schmidt CM, Turrini O, Parikh P, et al. Effect of hospital volume, surgeon experience, and surgeon volume on patient outcomes after pancreaticoduodenectomy: a single-institution experience. Arch Surg. 2010;145:634–640.
Liu Z, Peneva IS, Evison F, et al. Ninety day mortality following pancreatoduodenectomy in England: has the optimum centre volume been identified? HPB (Oxford). 2018;20:1012–1020.
Kulu Y, Schmied BM, Warner J, et al. Total pancreatectomy for pancreatic cancer: indications and operative technique. HPB (Oxford). 2009;11:469–475.
Demir IE, Jäger C, Schlitter MM, et al. R0 versus R1 resection matters after pancreaticoduodenectomy, and less after distal or total pancreatectomy for pancreatic cancer. Ann Surg. 2017;268:1058–1068.
Reddy S, Wolfgang CL, Cameron JL, et al. Total pancreatectomy for pancreatic adenocarcinoma: evaluation of morbidity and long-term Survival. Ann Surg. 2009;250:282–287.
Hartwig W, Gluth A, Hinz U, et al. Total pancreatectomy for primary pancreatic neoplasms: renaissance of an unpopular operation. Ann Surg. 2015;261:537–546.
Nathan H, Wolfgang CL, Edil BH, et al. Peri-operative mortality and long-term survival after total pancreatectomy for pancreatic adenocarcinoma: a population-based perspective. J Surg Oncol. 2009;99:87–92.
Murphy MM, Knaus WJ, Ng SC, et al. Total pancreatectomy: a national study. HPB (Oxford). 2009;11:476–482.
Johnston WC, Hoen HM, Cassera MA, et al. Total pancreatectomy for pancreatic ductal adenocarcinoma: review of the National Cancer Data Base. HPB (Oxford). 2016;18:21–28.
Sänchez-Veläzquez P, Muller X, Malleo G, et al. Benchmarks in pancreatic surgery: a novel tool for unbiased outcome comparisons. Ann Surg. 2019;270:211–218.
van Rijssen LB, Zwart MJ, van Dieren S, et al. Variation in hospital mortality after pancreatoduodenectomy is related to failure to rescue rather than major complications: a nationwide audit. HPB (Oxford). 2018;20:759–767.
Mackay TM, Wellner UF, van Rijssen LB, et al. Variation in pancreato-duodenectomy as delivered in two national audits. Br J Surg. 2019;106:747–755.
Tingstedt B, Andersson B, Jönsson C, et al. First results from the Swedish National Pancreatic and Periampullary Cancer Registry. HPB (Oxford). 2019;21:34–42.
Yang DJ, Xiong JJ, Liu XT, et al. Total pancreatectomy compared with pancreaticoduodenectomy: a systematic review and meta-analysis. Cancer Manag Res. 2019;11:3899–3908.
Lawthers A, McCarthy E, Davis R, et al. Identification of in-hospital complications from claims data. Is it valid? Med Care. 2000;38:785–795.