Impact factors for perioperative morbidity and mortality and repercussion of perioperative morbidity and long-term survival in pancreatic head resection

Type of all surgical complications (n = 240)	n	%	% 90-day mortality
No surgical complications	169	70.4	3
PF B or C	28	11.7	25
PF B or C and bleeding	8	3.3	62.5
Bleeding in the intestines	2	0.8	0
Intraabdominal bleeding – no PF	4	1.7	25
Bile leak	10	4.2	0
Leak from GEA	5	2.1	20
Dehiscence of laparotomy	3	1.3	0
Intraabdominal abscess	6	2.5	0
Ileus	1	0.4	0
Thrombosis of vascular graft	2	0.8	0
Volvulus coeci	1	0.4	0
Stenosis of coeliac trunk	1	0.4	0
Total	240	100.0	7.9%

Observed clinicopathological features in 240 operated patients

		P1 (n/%)	P2 (n/%)	All (n/%)	p
	male	51	80	131
	male	53.1%	55.6%	54.6%
Gender (n = 240)					0.4
	female	45	64	109
	female	46.9%	44.4%	45.4%
Age (n = 240)	Mean (years)	66.1 ± 9.9	65.98 ± 10.1	66.4	0.91
	1	17	43	17
	1	17.7%	29.9%	17.7%
ASA (n = 240)	2	53	68	53	0.103
ASA (n = 240)	2	55.2%	47.2%	55.2%	0.103
	3	26	33	26
	3	27.1%	22.9%	27.1%
Preoperative histology (n = 240)		4	32	36	0.0001
4.2%		22.2%	15.0%
Hospital stay (n = 222)	Mean (days)	21.2 ± 14.5	19 ± 11.6	19.8	0.138
Preoperative total bilirubin (n = 240)	Mean (mmol/l)(mmol/l)	67.6 ± 71.5	79.0 ± 85.5	74.7	0.028
Preoperative endoscopic biliary drainage (EBD) (n = 240)		34	51	85	0.554
Preoperative endoscopic biliary drainage (EBD) (n = 240)		35.4%	35.4%	35.4%

		P1(n/%)	P2(n/%)	All(n/%)	p

	PD	92	115	207
Type of pancreatic resection (n = 240)		95.8%	79.9%	86.3%	0.0001
	TP	4	29	33	0.0001
		4.2%	20.8%	14.2%
Resection of VMS/VP (n=240)		12	28	40	0.17
		12.5%	19.4%	16.7%	0.17
	Direct suture	10	14	24
Type of vascular reconstruction (n=240)		10.4%	9.7%	10.0%	0.043
	Vascular graft	2	14	16	0.043
		2.1%	9.7%	6.7%
Overall complications (OAC) (n=240)		34	55	89	0.383
35.4%		38.2%	37.1%		0.383
30-day mortality (n=240)		7	5	12	0.152
7.3%		3.5%	5.0%		0.152
90-day mortality (n=240)		11	8	19	0.080
11.5%		5.6%	7.9%		0.080

Correlation of clinicopathological factors and perioperative morbidity and mortality in 240 operated patients

	N		OAC	P	ASC	P	BC	P	OL	P	AA	P	PL	P	AGC	P
Age (years)	240	No compl.	64.6 ± 10	0.005	65.3 ± 10.3	0.051	66.2 ± 10	0.452	66 ± 10	0.665	65	0 056	65.7 ± 10	0.256	65.4 ± 10	0.007
Age (years)	240	Compl.	68.4 ± 9.1	0.005	67.9 ± 9.1	0.051	63.5 ± 12	0.452	67.1 ± 8	0.665	73	0 056	67.3 ± 8	0.256	70.1 ± 9	0.007
Age	240	<70	28.6%	0.011	23.8%	0.071	8.6%	0.094	4.8%	0.369	0%	0.030	16.3%	0.234	8.6%	0.021
(<70 and >69)	240	>69	43.7F%	0.011	33.3%	0.071	3.7%	0.094	6.7%	0.369	100%	0.030	21.4%	0.234	18.5%	0.021
ASA 1.2 vs. 3	240	ASA 1+2	32%	0.004	23.8%	0.042	5.5%	0.465	5.5%	0.465		0.457	16.1%	0.042	10.5%	0.006
ASA 1.2 vs. 3	240	ASA 3	52.5%	0.004	33.3%	0.042	6.8%	0.465	6.8%	0.465		0.457	29.5%	0.042	25.4%	0.006
Total bilirubin	240	No compl.	70.1 ± 74	0.271	68.3 ± 73.6	0.062	71 ± 77	0.005	74.4± 78	0.969		0.231	68.1 ± 70	0.195	79 ± 82	0.033
(mmol/l)	240	Compl.	82.9 ± 89	0.271	89.5 ± 93.1	0.062	134 ± 104	0.005	75.5 ± 108	0.969		0.231	91.4 ± 99	0.195	47.4 ± 61	0.033
EBD	240	No EBD	33.5%	0.082	24.5%	0.024	5.8%	0.594	7.1%	0.203		0.640	12.8%	0.004	11.6%	0.092
(no/yes)	240	EBD	43.5%	0.082	37.6%	0.024	5.9%	0.594	3.5%	0.203		0.640		0.004	30%	18.8%
PD/TP	240	PD	37.2%	0.545	29.5%	0.488	6.3%	0.400	5.8%	0.600	1%	0.004	-	-	13%	0.126
PD/TP	240	TP	36.4%	0.545	27.3%	0.488	3%	0.400	6.1%	0.600	12.1%	0.004	-	-	21.2%	0.126
Vasc. resect.	240	No vasc.	39.5%	0.115	30.0%	0.334	4.5%	0.063	6%	0.578		0.738	21.1%	0.083	16.5%	0.011
(yes/no)	240	Vasc. resect.	27.5%	0.115	25.0%	0.334	12.5%	0.063	5%	0.578		0.738	7.7%	0.083	2.5%	0.011
Size of tumor	201	No compl.	32.3 ± 19	0.001	31.7 ± 18.8	0.002	29.5 ± 17	0.187	29.4 ± 17	0.320		0.069	30.3 ± 18	0.001	29.7 ± 17	0.211
(mm)	201	Compl.	24.6 ± 12	0.001	23.7 ± 10.1	0.002	25 ± 10	0.187	25.1 ± 13	0.320		0.069	22.5 ± 9	0.001	25.7 ± 15	0.211
Type of tumor	216	PAC	34.1%	0.042	26.7%	0.074	6.7%	0.421	5.9%	0.435		0.403	16.2%	0.092	69.8 ± 183	0.094
PAC/NPC	216	NPC	46.9%	0.042	37.0%	0.074	4.9%	0.421	7.4%	0.435		0.403	25.7%	0.092	83.5 ± 127	0.094
Amylase level	187	No compl.	21.3 ± 62.1	0.0001	24.0 ± 73	0.0001	68.6 ± 175	0.333	72.3 ± 180	-0.773	72.5 ± 177	0.0001	22.2 ± 70	0.0001	69.8 ± 183	0.640
(ukat/l)	187	Compl.	150.6 ± 252	0.0001	179.9 ± 270	0.0001	128.1 ± 199	0.333	62.5 ± 100	-0.773	1.1 ± 1	0.0001	260 ± 310	0.0001	83.5 ± 127	0.640
Amylase	187	< 7	20.2%	0.0001	11.4%	0.0001	3.5%	0.022	1.7%	0.0001		0.529	19.1%	0.0001	35.6%	0.033
(>7 ukat/l)	187	> 7	69.8%	0.0001	61.6%	0.0001	12.7%	0.022	60.3%	0.0001		0.529	100%	0.0001	57.7%	0.033
PF C	187	No PF C	33.1%	0.0001	23.7%	0.0001	3%	0.0001		0.318		0.818	10.7%	0.0001	-	0.464
(yes/no)	187	PF C	100%	0.0001	100%	0.0001	38.9%	0.0001		0.318		0.818	100%	0.0001	-	0.464
PF B	187	No PF B	33.1%	0.0001	23.7%	0.0001	6.5%	0.676		0.318		0.818	10.7%	0.0001	-	0.221
(yes/no)	187	PF B	100%	0.0001	100%	0.0001	5.6%	0.676		0.318		0.818	100%	0.0001	-	0.221
PF A	187	No PF A	42.5%	0.035	36.3%	0.0001		0.148		0.171		0.734	24%	0.0001	-	0.141
(yes/no)	187	PF A	22.2%	0.035	0	0.0001		0.148		0.171		0.734	100%	0.0001	-	0.141
PF B or C	187	No PF B+C	25.2%.	0.0001	14.6%	0.0001	2.6%	0.0001		0.088		0.655
PF B or C	187	PF B+C	100%	0.0001	100%	0.0001	22.2	0.0001		0.088		0.655
Period of the study	240	P1	35.4%	0.383	25.0%	0.155	2.1%	0.036	5.2%	0.485		0.230	16.9%	0.292	17.7	0.137
Period of the study	240	P2	38.2%	0.383	31.9%	0.155	8.3%	0.036	6.3%	0.485		0.230	21.2%	0.292	11.8	0.137
Hospital stay	240		14.2 ± 4	0.0001	15.2 ± 6	0.0001	19.3 ± 13	0.003	18.1 ± 9	0.0001	19.6 ± 13	0.075	17.8 ± 12	0.0001	18.4 ± 12	0.0001
(days)	240		31.4 ± 16	0.0001	32.9 ± 17	0.0001	31.9 ± 8	0.003	44.9 ± 29	0.0001	29 ± 10	0.075	30.7 ± 9	0.0001	30.9 ± 10	0.0001

General complications in 240 operated patients

Type of all general complications (n = 240)	n	%	% 90-day mortality
No general complications	202	84.2	5.0
Pneumonia	8	3.3	25
Cardiorespiratory decompensation	3	1.3	100
Heart failure	9	3.8	11.1
Pulmonary embolism	4	1.7	25
Different infections	10	4.2	10
Renal failure	1	.4	100
Brain stroke	1	.4	0
Miscellaneous	2	.8	0
Total	240	100.0	7.9

Indications for pancreatic resection

Indication for pancreatic resection	P1	P2	All	p
Indication for pancreatic resection	(n/ %)	(n/ %)	(n/ %)	p
Pancreatic adeno carcinoma	64	71	135
Pancreatic adeno carcinoma	66.7%	50.0%	56.7%
Neuroendocrine tumor of the pancreas	2	7	9
Neuroendocrine tumor of the pancreas	2.1%	4.9%	3.8%
Main duct intraductal papillary mucinous neoplasm	0	3	3
Main duct intraductal papillary mucinous neoplasm	0.0%	1.4%	0.8%
Franz’s tumor	1	0	1
Franz’s tumor	1.0%	0.0%	0.4%
Non-Hodgkin lymphoma of the pancreas	1	1	2
Non-Hodgkin lymphoma of the pancreas	1.0%	0.7%	0.8%
Adenocarcinoma of the distal bile duct	13	30	43
Adenocarcinoma of the distal bile duct	13.5%	20.8%	17.9%
Adenocarcinoma of the papilla Vateri	12	18	30
Adenocarcinoma of the papilla Vateri	12.5%	12.5%	12.5%
Duodenal adenocarcinoma	2	6	8
Duodenal adenocarcinoma	2.1%	4.2%	3.3%
Gastric cancer	0	2	2
Gastric cancer	0.0%	1.4%	0.8%
Chronic pancreatitis	1	6	7
Chronic pancreatitis	1.0%	4.2%	2.9%

eISSN:: 1581-3207
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Impact factors for perioperative morbidity and mortality and repercussion of perioperative morbidity and long-term survival in pancreatic head resection

Article Category: Research Article

Published Online: Sep 14, 2017

Page range: 54 - 64

Received: Jun 11, 2017

Accepted: Aug 09, 2017

DOI: https://doi.org/10.1515/raon-2017-0036

© 2018 Stojan Potrc, Arpad Ivanecz, Vid Pivec, Urska Marolt, Sasa Rudolf, Bojan Iljevec, Tomaz Jagric

This article is distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Surgical complications in 240 operated patients

Observed clinicopathological features in 240 operated patients

Correlation of clinicopathological factors and perioperative morbidity and mortality in 240 operated patients

General complications in 240 operated patients

Indications for pancreatic resection