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

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.

Metadata

Item Type:	Article
Authors/Creators:	Russell, T.B. https://orcid.org/0000-0001-6836-3746 Labib, P.L. Denson, J. Streeter, A. https://orcid.org/0000-0001-9921-2369 Ausania, F. Pando, E. Roberts, K.J. Kausar, A. Mavroeidis, V.K. Marangoni, G. Thomasset, S.C. Frampton, A.E. Lykoudis, P. Maglione, M. https://orcid.org/0000-0003-1479-6129 Alhaboob, N. Bari, H. Smith, A.M. Spalding, D. Srinivasan, P. Davidson, B.R. Bhogal, R.H. Croagh, D. Dominguez, I. Thakkar, R. Gomez, D. Silva, M.A. Lapolla, P. Mingoli, A. Porcu, A. Shah, N.S. Hamady, Z.Z.R. Al-Sarrieh, B.A. Serrablo, A. Aroori, S. Labib, P.L. Russell, T.B. Streeter, A. Denson, J. Sheridan, D. Puckett, M. Browning, M.G. Ausania, F. Gonzalez-Abos, C. Pando, E. Fernandes, N. Moller, E.G. Taboada, C.D. Roberts, K.J. Pande, R. Alfarah, J. Kausar, A. Bandyopadhyay, S. Abdelrahim, A. Khan, A. Mavroeidis, V.K. Jordan, C. Rees, J.R.E. Marangoni, G. Blege, H. Thomasset, S.C. Cambridge, W. White, O. Frampton, A.E. Blacker, S. Blackburn, J. Sweeney, C. Lykoudis, P. Field, D. Gouda, M. Maglione, M. Bellotti, R. Alhaboob, N. Hamid, H.K.S. Bari, H. Ahmed, H. Smith, A.M. Moriarty, C. White, L. Priestley, M. Bode, K. Sharp, J. Wragg, R. Jackson, B. Craven, S. Spalding, D. Fehervari, M. Pai, M. Alghazawi, L. Onifade, A. Srinivasan, P. Ribaud, J. Nair, A. Mariathasan, M. Grayson, N. Davidson, B.R. Pericleous, S. Patel, K. Shaw, C. Morare, N. Zaban, M.K. Bhogal, R.H. Doyle, J. Mavroeidis, V.K. Croagh, D. Dominguez, I. Guerrero, A. Moguel, A. Chan, C. Thakkar, R. Jones, M. Buckley, E. Akter, N. Treherne, K. Gomez, D. Gordon, G. Silva, M.A. Hughes, D. Urbonas, T. Lapolla, P. Mingoli, A. Brachini, G. Caronna, R. Chirletti, P. Porcu, A. Perra, T. Shah, N.S. Kahar, N.N.A. Hall, T. Nadeem, N. Hamady, Z.Z.R. Karar, S. Arshad, A. Al-Sarrieh, B. Yarwood, A. Hammoda, M. Serrablo, A. Artigas, M. Paterna-López, S. Aroori, S. https://orcid.org/0000-0002-5613-6463
Copyright, Publisher and Additional Information:	© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
Keywords:	RAW Study Collaborators ; Pancreas; Humans; Pancreatic Neoplasms; Pancreatic Fistula; Postoperative Complications; Pancreaticoduodenectomy; Retrospective Studies
Dates:	Published: 1 November 2023 Published (online): 30 November 2023 Accepted: 27 August 2023
Institution:	The University of Leeds
Depositing User:	Symplectic Publications
Date Deposited:	05 Jan 2024 11:30
Last Modified:	05 Jan 2024 11:30
Published Version:	http://dx.doi.org/10.1093/bjsopen/zrad106
Status:	Published
Publisher:	Oxford University Press (OUP)
Identification Number:	10.1093/bjsopen/zrad106
Related URLs:	PubMed URL
Open Archives Initiative ID (OAI ID):	oai:eprints.whiterose.ac.uk:207101

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

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