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Factors Predictive of Reoperation After Pancreaticoduodenectomy for Pancreatic Cancer

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Abstract

While mortality is low, morbidity remains high for patients undergoing pancreas resections, especially for those who return to the operating room (RTOR). The aim of this study is to identify risk factors for RTOR following pancreaticoduodenectomy (PD) for ductal adenocarcinoma. Logistic regression models were constructed using the 2014 and 2015 National Surgical Quality Improvement Program (NSQIP) Pancreas Targeted database. Preoperative and procedure-related risk factors predictive of RTOR for patients undergoing either classic or pylorus-preserving pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC) were identified. A total of 1736 patients were included. Multivariable analysis of patients undergoing classic PD demonstrated that an abnormally low preoperative WBC count was significantly associated with RTOR (OR 2.78, 95% CI 1.27–6.06, p = 0.010). For patients who underwent pylorus-preserving PD, the wound classification (OR 3.99, 95% CI 1.75–9.11, p = 0.001) and arterial resection (OR 26.3, 95% CI 7.96–87.20, p < 0.001) were associated with a higher rate of RTOR. When analyzing both approaches (classic and pylorus-preserving PD) together, only isolated arterial (OR 9.98, 95% CI 3.81–26.18, p < 0.001) and isolated venous (OR 1.79, 95% CI 1.05–3.05, p = 0.032) resections were independently associated with RTOR. The results of our study demonstrate that few factors are predictive of RTOR. Knowledge of these few variables in combination with a focus on the components of medical care in the immediate postoperative period may help identify individuals at risk for RTOR and improve patient care.

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Authors and Affiliations

  1. Department of General Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, Omaha, NE, 68198-3280, USA

    Bradley R. Hall & Chandrakanth Are

  2. College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA

    Richard Sleightholm

  3. College of Public Health, Division of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA

    Lynette Smith & Harlan Sayles

  4. Fred and Pamela Buffet Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA

    Chandrakanth Are

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  1. Bradley R. Hall
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  2. Richard Sleightholm
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  4. Harlan Sayles
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  5. Chandrakanth Are
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Contributions

CA was responsible for the initial concept of this study. BRH was responsible for methods, and writing of the manuscript. RS and HS, under the guidance of LS, are responsible for all data and statistical analysis. CA is responsible for project oversight and editing of the manuscript. The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Correspondence to Chandrakanth Are.

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Hall, B.R., Sleightholm, R., Smith, L. et al. Factors Predictive of Reoperation After Pancreaticoduodenectomy for Pancreatic Cancer. Indian J Surg Oncol 10, 237–244 (2019). https://doi.org/10.1007/s13193-019-00913-w

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  • DOI: https://doi.org/10.1007/s13193-019-00913-w

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