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Russell, Thomas B; Labib, Peter L; Denson, Jemimah; Streeter, Adam; Ausania, Fabio; Pando, Elizabeth; Roberts, Keith J; Kausar, Ambareen; Mavroeidis, Vasileios K; Marangoni, Gabriele; Thomasset, Sarah C; Frampton, Adam E; Lykoudis, Pavlos; Maglione, Manuel; Alhaboob, Nassir; Bari, Hassaan; Smith, Andrew M; Spalding, Duncan; Srinivasan, Parthi; Davidson, Brian R; Bhogal, Ricky H; Croagh, Daniel; Dominguez, Ismael; Thakkar, Rohan; [...]

Postoperative complications after pancreatoduodenectomy for malignancy: results from the Recurrence After Whipple’s (RAW) study

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  • Media type: E-Article
  • Title: Postoperative complications after pancreatoduodenectomy for malignancy: results from the Recurrence After Whipple’s (RAW) study
  • Contributor: Russell, Thomas B; Labib, Peter L; Denson, Jemimah; Streeter, Adam; Ausania, Fabio; Pando, Elizabeth; Roberts, Keith J; Kausar, Ambareen; Mavroeidis, Vasileios K; Marangoni, Gabriele; Thomasset, Sarah C; Frampton, Adam E; Lykoudis, Pavlos; Maglione, Manuel; Alhaboob, Nassir; Bari, Hassaan; Smith, Andrew M; Spalding, Duncan; Srinivasan, Parthi; Davidson, Brian R; Bhogal, Ricky H; Croagh, Daniel; Dominguez, Ismael; Thakkar, Rohan; [...]
  • Published: Oxford University Press (OUP), 2023
  • Published in: BJS Open, 7 (2023) 6
  • Language: English
  • DOI: 10.1093/bjsopen/zrad106
  • ISSN: 2474-9842
  • Origination:
  • Footnote:
  • Description: Abstract Background Pancreatoduodenectomy (PD) is associated with significant postoperative morbidity. Surgeons should have a sound understanding of the potential complications for consenting and benchmarking purposes. Furthermore, preoperative identification of high-risk patients can guide patient selection and potentially allow for targeted prehabilitation and/or individualized treatment regimens. Using a large multicentre cohort, this study aimed to calculate the incidence of all PD complications and identify risk factors. Method Data were extracted from the Recurrence After Whipple’s (RAW) study, a retrospective cohort study of PD outcomes (29 centres from 8 countries, 2012–2015). The incidence and severity of all complications was recorded and potential risk factors for morbidity, major morbidity (Clavien–Dindo grade > IIIa), postoperative pancreatic fistula (POPF), post-pancreatectomy haemorrhage (PPH) and 90-day mortality were investigated. Results Among the 1348 included patients, overall morbidity, major morbidity, POPF, PPH and perioperative death affected 53 per cent (n = 720), 17 per cent (n = 228), 8 per cent (n = 108), 6 per cent (n = 84) and 4 per cent (n = 53), respectively. Following multivariable tests, a high BMI (P = 0.007), an ASA grade > II (P < 0.0001) and a classic Whipple approach (P = 0.005) were all associated with increased overall morbidity. In addition, ASA grade > II patients were at increased risk of major morbidity (P < 0.0001), and a raised BMI correlated with a greater risk of POPF (P = 0.001). Conclusion In this multicentre study of PD outcomes, an ASA grade > II was a risk factor for major morbidity and a high BMI was a risk factor for POPF. Patients who are preoperatively identified to be high risk may benefit from targeted prehabilitation or individualized treatment regimens.
  • Access State: Open Access