Postoperative complications after pancreatoduodenectomy for malignancy: results from the Recurrence After Whipple’s (RAW) study
Thomas Russell, Peter Labib, Jemimah Denson, Adam Streeter, Fabio Ausania, Elizabeth Pando, Keith Roberts, Ambareen Kausar, Vasileios Mavroeidis, Gabriele Marangoni, Sarah Thomasset, Adam E. Frampton, Pavlos Lykoudis, Manuel Maglione, Nassir Alhaboob, Hassaan Bari, Andrew M. Smith, Duncan Spalding, Parthi Srinivasan, Brian R Davidson, Ricky H. Bhogal, Daniel Croagh, Ismael Domínguez, Rohan Thakkar, Dhanny Gomez, Michael A. Silva, Pierfrancesco Lapolla, Andrea Mingoli, Alberto Porcu, Nehal Shah, Zaed Hamady, Bilal Al-Sarrieh, Alejandro Serrablo, RAW Study Collaborators, Somaiah Aroori, Peter Labib, Thomas Russell, Adam Streeter, Jemimah Denson, David C. Sheridan, Mark Puckett, Matthew G. Browning, Fabio Ausania, Carolina González‐Abós, Elizabeth Pando, Nair Fernandes, Elsa Garcia Moller, Cristina Dopazo Taboada, Keith Roberts, Rupaly Pandé, Jameel Alfarah, Ambareen Kausar, Samik Bandyopadhyay, Ahmed Abdel-Rahim, Ayesha Khan, Vasileios Mavroeidis, Caitlin Jordan, Jonathan Rees, Gabriele Marangoni, Harry Blege, Sarah Thomasset, William Cambridge, Olga White, Adam E. Frampton, Sarah Blacker, Jessie Blackburn, Casie Sweeney, Pavlos Lykoudis, Daniel Field, Mohammed Gouda, Manuel Maglione, Ruben Bellotti, Nassir Alhaboob, Hytham K. S. Hamid, Hassaan Bari, Hassan Ahmed, Andrew M. Smith, Catherine Moriarty, Louise G. White, Mark Priestley, Kerry Bode, J. A. Sharp, Rosie Wragg, Beverley Jackson, Samuel Craven, Duncan Spalding, Matyas Fehervari, Madhava Pai, Laith Alghazawi, Anjola Onifade, Parthi Srinivasan, Julliette Ribaud, Ashitha Nair, Michael Mariathasan, Niamh Grayson, Brian R Davidson, Stephanos Pericleous, Krishna Patel, Conrad Shaw, Nolitha Morare
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.