Perioperative Risk Factors & Outcome After Pancreatico-Duodenectomy (Whipple Procedure) Perioperative Risk Factors & Outcome After Pancreatico-Duodenectomy (Whipple Procedure)
Main Article Content
Keywords
Pancreatico-Duodenectomy, Whipple Procedure,, Periampullary cancers, basrah
Abstract
Background: Periampullary cancers have poor prognosis, mainly due to late diagnosis. Although pancreaticoduodenectomy is considered the only possible curative option for these cancers, it is associated with high morbidity and mortality.
Aim: To identify the risk factors associated with postoperative morbidity and mortality.
Patients and Methods: Data were prospectively collected from the 44 patients who underwent pancreaticoduodenectomy for periampullary cancers in Al-Sader Teaching Hospital, Basrah, Iraq, from June 2017 to June 2020. These variables were reviewed according to developing postoperative morbidity and mortality. The statistical analysis was done using SPSS version 23 and the chi-squared or Fisher’s exact (FE) test. Any level of significance below 0.05 was considered statistically significant.
Results: Increased age and the presence of preoperative co-morbidities are independent predictors of developing postoperative morbidity and mortality. The most common postoperative complications leading to mortality are pulmonary embolisms and pancreatic leaks.
Conclusion: Improvement in the management of comorbidities and perioperative care are essential in decreasing postoperative morbidity and mortality.
References
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9. Jordan M Winter, John L Cameron, et al. 1423 Pancreaticoduodenectomies for Pancreatic Cancer: A Single Institution Experience. J Gastrointest Surg. 2006 Nov; 10(9):1199-210.
10. M Squadroni, N Fazio. Chemotherapy in Pancreatic Adenocarcinoma. Eur Rev Med Pharmacol Sci. 2010 Apr; 14(4):386-94.
11. Georg Wiltberger, Babett Muhl, et al. Preoperative Risk Stratification for Major Complications Following Pancreaticoduodenectomy: Identification of High Risk Patients. Journal-surgery.net. 25 April 2016.
12. Georg Wiltberger, Felix Krenzien, et al. Prognostic Accuracy of the Seventh Edition of the TMN Classification Compared with the Fifth and Sixth Edition for Distal Cholangiocarcinoma. Annals of Surgical Oncology. 2016 23(4):1320-1326.
13. Schmidt, C.M, et al. Effect of Hospital Volume, Surgeon Experience, and Surgeon Volume on Patient Outcomes after Pancreaticoduodenectomy: A Single Institution Experience. Arch Surg, 2010.145(7):p. 634-40.
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15. Birkmeyer JD, Finlayson SR, Tosteson AN, et al. Effect of Hospital Volume on In-hospital Mortality with Pancreaticoduodenectomy. Surgery. 1999; 125:250.
16. R F de Wilde, M G H Besselink, et al. Impact of Nationwide Centralization of Pancreaticoduodenectomy on Hospital Mortality. Br J Surg. 2010 Mar; 99(3):404-10.
17. Nicolo Pecorelli, Gianpaolo Balzano, et al. Effect of Surgeon Volume on Outcome Following Pancreaticoduodenectomy in a High-volume Hospital. J Gastrointest Surg. 2012 Mar; 16(3):518-23.
18. Stojan Potrc. Arpad Ivanecz, et al. Impact Factor for Preoperative Morbidity and Mortality and Repercussion of Perioperative Morbidity and Long term Survival in Pancreatic Head Resection. Radiol oncol. 2018 Mar; 52(1):54-64.
19. Choon Kiat Ho, Jorg Kleeff, et al. Complications of Pancreatic Surgery. Hepatobiliary Journal. 2005 Feb; 7(2):99-108.
20. Kyla Terhune, Nipun B. Merchant, et al. Complication of Pancraticoduodenectomy. Tomur Oncology series. 2008; 4:365-384.
21. Rahunandan Venkat, Milo A, et al. Predicting the Risk of Perioperative Mortality in Patients Undergoing Pancreaticoduodenectomy. Arch Surg. 2011; 146(11):1277-1284.
22. Squillaci E, Fanucco E, Scuito F; Vascular Involvement in Pancreatic Neoplasm: A Comparison between Spiral CT and DSA. Dig Dis Sci. 2003; 48:449-458.
23. Bachellier P, Nakano H, Oussoultzoglou PD, et al. Is Pancreaticoduodenectomy with ZMesentericoportal Venous Resection Safe and Worthwhile? Am J Surg. 2001; 182: 120-129.
24. Somaiah Aroori, John Isaac, et al. Outcomes Comparing a Pancreaticogastrostomy (PG) and a Pancreaticojejunostomy (PJ) After a Pancreaticoduodenectomy (PD). Hepato-Pancreato-Biliary Journal Volume 13. 2011 October; 13(10): 723-731.
25. Fisher WE, Hodges SE, Silbefein EJ, et al. Pancreatic Resection Without Routine Intraperitoneal Drainage. The Oxford Hepato-Pancreato-Biliary Journal. 2011 July; 13(7): 503-510.
26. Kazanjian KK, Hines OJ, Eibl G, Reber HA. Management of Pancreatic Fistulas After Pancreaticoduodenectomy: Results in 437 Consecutive Patients. Arch Surg. 2005; 140:849-854, discussion 854-856.
27. Mortiz N Wente, Claudio Bessi, et al. Delayed Gastric Emptying (DGE) After Pancreatic Surgery: A Suggested Definition By the International Study Group of Pancreatic Surgery (ISGPS). National Library of Medicine. 2007 Nov; 142(5):761-8.
28. Gordon TA, Bowman HM, Tielsch JM, et al. State wide Regionalization of Pancreaticoduodenectomy and its Effect on In-hospital Mortality. Ann Surg. 1998; 228:71-78.
29. P.M Grambsch, T.M Therneau. Proportional Hazarde Tests and Diagnoistics Based on Weighted Residuals. Biometrika. 81(3) (1994) 515-526.
30. S.G de la Fuente, K.M. Bennett, T.N. Pappas, et al. Pre- and Intra-operative Variable Affecting Early Outcomes in Elderly Patients Undergoing Pancreaticoduodenectomy. HPB Oxf. 13(12) (2001) 887-892.
31. M. Braga, G. Capretti, et al. A Prognostic Score to Predict Major Complication After Pancreaticoduodenectomy. Annals of Surgery. 254(5) (2011) 702-708.
32. Ajith Prasad J. S, Sharath Kumar. Postoperative Morbidity Following Whipple Procedure for Periampullary Carcinoma: A Retrospective Study Spanning 5 Years. International Journal of Research in Medical Sciences. 2019 Nov; 7 (11): 4314-4319.
33. Philip I. Haigh, MD, MSc, FRCSC; Karl Y. Bilimoria, MD; L. Andrew DiFronzo, MD. Early Postoperative Outcomes After Pancreaticoduodenectomy in the Elderly. Arch Surg. 2011;146(6):715-723.
34. Michael G. House, Yuman Fong, Dean J. Arnaoutakis, Rohit Sharma, Corinne B. Winston, Mladjan Protic, Mithat Gonen, Sara H. Olson, Robert C. Kurtz, Murray F. Brennan & Peter J. Allen. Preoperative Predictors for Complications after Pancreaticoduodenectomy. Journal of Gastrointestinal Surgery 12, 270–278 (2008).
35. Charles J. Yeo, MD, John L. Cameron, MD, Taylor A. Sohn, MD, JoAnn Coleman, RN, Patricia K. Sauter, RN, Ralph H. Hruban, MD, Henry A. Pitt, MD, and Keith D. Lillemoe, MD. Pancreaticoduodenectomy With or Without Extended Retroperitoneal Lymphadenectomy for Periampullary Adenocarcinoma. Ann Surg. 1999 May; 229(5): 613.
36. David Yu Greenblatt MD, MSPH, Kaitlyn J. Kelly MD, Victoria Rajamanickam MS, Yin Wan MS, Todd Hanson BS, Robert Rettammel MA, Emily R. Winslow MD, Clifford S. Cho MD, FACS & Sharon M. Weber MD, FACS. Preoperative Factors Predict Perioperative Morbidity and Mortality After Pancreaticoduodenectomy. Annals of Surgical Oncology. 18, 2126-2135(2011).
37. Grobmyer SR, Pieracci FM, Allen PJ, Brennan MF, Jaques DP. Defining Morbidity After Pancreaticoduodenectomy: Use of A Prospective Complication Grading System. J Am Coll Surgeo. 2007 Mar 1; 204(3):356-64.
38. Nagle RT, Leiby BE, Lavu H, Rosato EL, Yeo CJ, Winter JM. Pneumonia is Associated with a High Risk of Mortality After Pancreaticoduodenectomy. Surgery. 2017 Apr 1; 161(4):959-67.
2. Seigel R, Naishadham D, Jemal A. Cancer Statistics 2012. CA: A Cancer Journal for Clinicians. 2012; 62:10-29.
3. Y. H. Shaib, J. A. Davila, H. B. El-Serag. The Epidemiology of Pancreatic Cancer in the United States: Changes below the Surface. Aliment Pharmacol Ther. 2006; 24(1):87-94.
4. Wilentz RE, Hruban RH. Pathology of Cancer of the Pancreas. Surg Oncol Clin N Am. 1998; 7:43-65.
5. Shuichi Aoki, Hiroaki Miyata, Michiki Unno, et al. Risk Factor of Serious Postoperative Complications After Pancreaticoduodenectomy and Risk Calculators for Predicting Postoperative Complications: a National Study of 17,564 Patients in Japan. Journal of Hepatobiliary Pancreatic Science. 2017 May; 24(5):243-251.
6. Yael Vin, Camelia S Sima, et al. Management and Outcomes of Post-pancreatectomy Fistula, Leak and Abscess: Result of 908 Patients Resected at a Single Institution Between 2000 and 2005. J Am Coll Surg. 2008 Oct; 207(4):490-8.
7. Gillen S, Schuster T, Meyer Zum Buschenfelde C, et al. Preoperative Neoadjuvant Therapy in Pancreatic Cancer: A Systematic Review and Meta-analysis of Response and Resection Percentages. PLoS Med. 7(4): e1000267. Doi: 10:1371/journal.pmed.1000267.
8. Glazer, E., Amini, A., Jie, T., Gruessner, R., Krouse, R., & Ong, E. (2013). Recognition of Complications After Pancreaticoduodenectomy for Cancer Determines Inpatient Mortality. Journal of the Pancreas. 2013 November; 14(6), 626-631.
9. Jordan M Winter, John L Cameron, et al. 1423 Pancreaticoduodenectomies for Pancreatic Cancer: A Single Institution Experience. J Gastrointest Surg. 2006 Nov; 10(9):1199-210.
10. M Squadroni, N Fazio. Chemotherapy in Pancreatic Adenocarcinoma. Eur Rev Med Pharmacol Sci. 2010 Apr; 14(4):386-94.
11. Georg Wiltberger, Babett Muhl, et al. Preoperative Risk Stratification for Major Complications Following Pancreaticoduodenectomy: Identification of High Risk Patients. Journal-surgery.net. 25 April 2016.
12. Georg Wiltberger, Felix Krenzien, et al. Prognostic Accuracy of the Seventh Edition of the TMN Classification Compared with the Fifth and Sixth Edition for Distal Cholangiocarcinoma. Annals of Surgical Oncology. 2016 23(4):1320-1326.
13. Schmidt, C.M, et al. Effect of Hospital Volume, Surgeon Experience, and Surgeon Volume on Patient Outcomes after Pancreaticoduodenectomy: A Single Institution Experience. Arch Surg, 2010.145(7):p. 634-40.
14. Venu Madhav, Surya Ramachandra Varma Gunturi, et al. Assessment of Risk Factor for Complication after Pancreatic Surgery. International Journal of Surgery Science. 2019; 3(4):92-99.
15. Birkmeyer JD, Finlayson SR, Tosteson AN, et al. Effect of Hospital Volume on In-hospital Mortality with Pancreaticoduodenectomy. Surgery. 1999; 125:250.
16. R F de Wilde, M G H Besselink, et al. Impact of Nationwide Centralization of Pancreaticoduodenectomy on Hospital Mortality. Br J Surg. 2010 Mar; 99(3):404-10.
17. Nicolo Pecorelli, Gianpaolo Balzano, et al. Effect of Surgeon Volume on Outcome Following Pancreaticoduodenectomy in a High-volume Hospital. J Gastrointest Surg. 2012 Mar; 16(3):518-23.
18. Stojan Potrc. Arpad Ivanecz, et al. Impact Factor for Preoperative Morbidity and Mortality and Repercussion of Perioperative Morbidity and Long term Survival in Pancreatic Head Resection. Radiol oncol. 2018 Mar; 52(1):54-64.
19. Choon Kiat Ho, Jorg Kleeff, et al. Complications of Pancreatic Surgery. Hepatobiliary Journal. 2005 Feb; 7(2):99-108.
20. Kyla Terhune, Nipun B. Merchant, et al. Complication of Pancraticoduodenectomy. Tomur Oncology series. 2008; 4:365-384.
21. Rahunandan Venkat, Milo A, et al. Predicting the Risk of Perioperative Mortality in Patients Undergoing Pancreaticoduodenectomy. Arch Surg. 2011; 146(11):1277-1284.
22. Squillaci E, Fanucco E, Scuito F; Vascular Involvement in Pancreatic Neoplasm: A Comparison between Spiral CT and DSA. Dig Dis Sci. 2003; 48:449-458.
23. Bachellier P, Nakano H, Oussoultzoglou PD, et al. Is Pancreaticoduodenectomy with ZMesentericoportal Venous Resection Safe and Worthwhile? Am J Surg. 2001; 182: 120-129.
24. Somaiah Aroori, John Isaac, et al. Outcomes Comparing a Pancreaticogastrostomy (PG) and a Pancreaticojejunostomy (PJ) After a Pancreaticoduodenectomy (PD). Hepato-Pancreato-Biliary Journal Volume 13. 2011 October; 13(10): 723-731.
25. Fisher WE, Hodges SE, Silbefein EJ, et al. Pancreatic Resection Without Routine Intraperitoneal Drainage. The Oxford Hepato-Pancreato-Biliary Journal. 2011 July; 13(7): 503-510.
26. Kazanjian KK, Hines OJ, Eibl G, Reber HA. Management of Pancreatic Fistulas After Pancreaticoduodenectomy: Results in 437 Consecutive Patients. Arch Surg. 2005; 140:849-854, discussion 854-856.
27. Mortiz N Wente, Claudio Bessi, et al. Delayed Gastric Emptying (DGE) After Pancreatic Surgery: A Suggested Definition By the International Study Group of Pancreatic Surgery (ISGPS). National Library of Medicine. 2007 Nov; 142(5):761-8.
28. Gordon TA, Bowman HM, Tielsch JM, et al. State wide Regionalization of Pancreaticoduodenectomy and its Effect on In-hospital Mortality. Ann Surg. 1998; 228:71-78.
29. P.M Grambsch, T.M Therneau. Proportional Hazarde Tests and Diagnoistics Based on Weighted Residuals. Biometrika. 81(3) (1994) 515-526.
30. S.G de la Fuente, K.M. Bennett, T.N. Pappas, et al. Pre- and Intra-operative Variable Affecting Early Outcomes in Elderly Patients Undergoing Pancreaticoduodenectomy. HPB Oxf. 13(12) (2001) 887-892.
31. M. Braga, G. Capretti, et al. A Prognostic Score to Predict Major Complication After Pancreaticoduodenectomy. Annals of Surgery. 254(5) (2011) 702-708.
32. Ajith Prasad J. S, Sharath Kumar. Postoperative Morbidity Following Whipple Procedure for Periampullary Carcinoma: A Retrospective Study Spanning 5 Years. International Journal of Research in Medical Sciences. 2019 Nov; 7 (11): 4314-4319.
33. Philip I. Haigh, MD, MSc, FRCSC; Karl Y. Bilimoria, MD; L. Andrew DiFronzo, MD. Early Postoperative Outcomes After Pancreaticoduodenectomy in the Elderly. Arch Surg. 2011;146(6):715-723.
34. Michael G. House, Yuman Fong, Dean J. Arnaoutakis, Rohit Sharma, Corinne B. Winston, Mladjan Protic, Mithat Gonen, Sara H. Olson, Robert C. Kurtz, Murray F. Brennan & Peter J. Allen. Preoperative Predictors for Complications after Pancreaticoduodenectomy. Journal of Gastrointestinal Surgery 12, 270–278 (2008).
35. Charles J. Yeo, MD, John L. Cameron, MD, Taylor A. Sohn, MD, JoAnn Coleman, RN, Patricia K. Sauter, RN, Ralph H. Hruban, MD, Henry A. Pitt, MD, and Keith D. Lillemoe, MD. Pancreaticoduodenectomy With or Without Extended Retroperitoneal Lymphadenectomy for Periampullary Adenocarcinoma. Ann Surg. 1999 May; 229(5): 613.
36. David Yu Greenblatt MD, MSPH, Kaitlyn J. Kelly MD, Victoria Rajamanickam MS, Yin Wan MS, Todd Hanson BS, Robert Rettammel MA, Emily R. Winslow MD, Clifford S. Cho MD, FACS & Sharon M. Weber MD, FACS. Preoperative Factors Predict Perioperative Morbidity and Mortality After Pancreaticoduodenectomy. Annals of Surgical Oncology. 18, 2126-2135(2011).
37. Grobmyer SR, Pieracci FM, Allen PJ, Brennan MF, Jaques DP. Defining Morbidity After Pancreaticoduodenectomy: Use of A Prospective Complication Grading System. J Am Coll Surgeo. 2007 Mar 1; 204(3):356-64.
38. Nagle RT, Leiby BE, Lavu H, Rosato EL, Yeo CJ, Winter JM. Pneumonia is Associated with a High Risk of Mortality After Pancreaticoduodenectomy. Surgery. 2017 Apr 1; 161(4):959-67.
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Perioperative Risk Factors & Outcome After Pancreatico-Duodenectomy (Whipple Procedure): Perioperative Risk Factors & Outcome After Pancreatico-Duodenectomy (Whipple Procedure). Iraqi Natl J Med [Internet]. 2022 Jan. 15 [cited 2024 Nov. 15];4(1):71-9. Available from: https://iqnjm.com/index.php/homepage/article/view/67
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