Uğur TOPAL, Türkmen Bahadır ARIKAN, Erdoğan Mütevelli SÖZÜER, Fatih DAL, Gamze Kübra BOZKURT

Evaluation of factors related to postoperative mortality in patients who underwent pancreatoduodenectomy due to periampullary region tumors

Aim: In this study, we aimed to investigate the factors related to postoperative mortality after pancreatoduodenectomy in our clinic.Materials and Methods: Patients who underwent pancreatoduodenectomy due to a periampullary region tumor between 2010 and2019 were included in the study. Mortality that occurred within 30 days after PD was defined as postoperative mortality and groupswere formed according to this definition Group 1(Postoperative Mortality) and Group 2(No mortality). The demographic and clinicalfeatures, laboratory parameters, and tumor features of the patients were compared between the groups. Risk factors for mortalitywere analyzed by univariate analysis and multivariate logistic regression analysis.Results: 155 patients participated in our study. We found our postoperative mortality rate as 11.6%. Accordingly, Group 1 consistedof 18 and Group 2 consisted of 137 patients. The sex was similar (p: 0.235). The average age was higher in Group 1 than 2 (71.2 vs63.7, p:0.013). Tumor localizations were similar in groups (p:0.275). Lymph node positivity was similar in the groups (50% vs 41.6%,p:0.333). The pancreatic fistula was higher in Group 1, but not statistically significant (33% vs 18.2%, p:0.119). Preoperative whiteblood cell count (9490 mm3 vs 8050 mm3) and neutrophil count (6898 mm3 vs5442 mm3) were higher in Group 1. In multivariateanalysis, no parameters were single-handedly risk factors.Conclusion: No factor was found to be effective alone in the development of mortality after pancreaticoduodenectomy. We think thatpostoperative mortality may decrease by revealing the factors in the preoperative, intraoperative and postoperative periods.

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1. Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 11 [Internet].Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://globocan.iarc.fr, Accessed 2016.
2. Ferlay J, Soerjomataram I, Dikshit R, et al . Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:359-86.
3. Macedo FIB, Jayanthi P, Mowzoon M , et al. The impact of surgeon volume on outcomes after pancreaticoduodenectomy: a meta-analysis. J Gastrointest Surg 2017;21:1723-31.
4. Kimura W, Miyata H, Gotoh M, et al. A pancreaticoduodenectomy risk model derived from 8575 cases from a national single-race population (Japanese) using a web-based data entry system: the 30-day and in-hospital mortality rates for pancreaticoduodenectomy. Ann Surg 2014;259:773- 80.
5. Yeo CJ, Cameron JL, Sohn TA , et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 1997;226:248-57.
6. Simons JP, Shah SA, Ng SC, et al National complication rates after pancreatectomy: beyond mere mortality. J Gastrointest Surg 2009;13:1798-805.
7. Balzano G, Zerbi A, Capretti G, et al. Effect of hospital volume on outcome of pancreaticoduodenectomy in Italy. Br J Surg 2008;95:357-62.
8. Yoshioka R, Yasunaga H, Hasegawa , et al. Impact of hospital volume on hospital mortality, length of stay and total costs after pancreaticoduodenectomy. Br J Surg 2014;101:523-9. 9. Nimptsch U, Krautz C, Weber GF , et al .Nationwide in-hospital mortality following pancreatic surgery in Germany is higher than anticipated. Ann Surg 2016;264:1082-90.
10. Greenblatt DY, Kelly KJ, Rajamanickam V, et al. Preoperative factors predict perioperative morbidity and mortality after pancreaticoduodenectomy. Ann Surg Oncol 2011;18:2126-35.
11. Hill JS, Zhou Z, Simons JP, et al. A simple risk score to predict in-hospital mortality after pancreatic resection for cancer. Ann Surg Oncol 2010;17:1802-7.
12. Bassi C, Dervenis C, Butturini G, et al. International Study Group on Pancreatic Fistula Definition: Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8- 13.
13. Wente MN, Veit JA, Bassi C, et al Postpancreatectomy hemorrhage (PPH)–an international study group of pancreatic surgery (ISGPS) definition. Surgery 2007;142:20-5.
14. Kim CG, Jo S, Kim JS. Impact of surgical volume on nationwide hospital mortality after pancreaticoduodenectomy. World J Gastroenterol 2012;18:4175-8
15. Gilsdorf RB, Spanos P. Factors influencing morbidity and mortality in pancreaticoduodenectomy. Ann Surg 1973;177:332-7.
16. Monge JJ, Judd ES, Gage RP. Radical pancreaticoduodenectomy: a 22-year experience with complications, mortality rate and survival rate. Ann Surg 1964;160:711-22.
17. Parikh P, Shiloach M, Cohen ME, et al. Pancreatectomy risk calculator: an ACS-NSQIP resource. HPB. 2010;12:488-97.
18. Eppsteiner RW, Csikesz NG, McPhee JT, et al. Surgeon volume impacts hospital mortality for pancreatic resection. Ann Surg 2009;249:635-40.
19. Hata T, Motoi F, Ishida M, et al Effect of hospital volume on surgical outcomes after pancreaticoduodenectomy. Ann Surg 2016;263:664-72.
20. Nathan H, Cameron JL, Choti MA, et al. The volume– outcomes effect in hepato-pancreato-biliary surgery: hospital versus surgeon contributions and specificity of the relationship. J Am Coll Surg 2009;208:528-38.
21. Sosa JA, Bowman HM, Gordon TA, et al. Importance of Hospital Volume in the Overall Management of Pancreatic Cancer. Ann Surg 1998;228:429-38.
22. Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic adenocarcinoma, version 2.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2017;15:1028-61.
23. Macedo FIB, Jayanthi P, Mowzoon M, et al. The impact of surgeon volume on outcomes after pancreaticoduodenectomy: a meta-analysis. JJ Gastrointest Surg 2017;21:1723-31.
24. Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality associated with inpatient surgery. N Engl J Med 2009;361:1368-75.
25. Yuan F, Essaji Y, Belley-Cote EP, et al. Postoperative complications in elderly patients following pancreaticoduodenectomy lead to increased postoperative mortality and costs. A retrospective cohort study. International J Surgery 2018;60:204-9.
26. McMillan MT, AllegriniV, Asbun HJ ,et al. Incorporation of procedure-specific risk into the ACS-NSQIP surgical risk calculator improves the prediction of morbidity and mortality after pancreatoduodenectomy. Ann Surg 2017;265:978-86.
27. Greenblatt DY, Kelly KJ, Rajamanickam V, et al. Preoperative factors predict perioperative morbidity and mortality after pancreaticoduodenectomy. Ann Surg Oncol 2011;11:2126-35.
28. Pomianowska E, Grzyb K, Westgaard A, et al. Reclassification of tumour origin in resected periampullary adenocarcinomas reveals underestimation of distal bile duct cancer. EJSO 2012;38:1043-50.
29. Winter JM, Cameron JL, Yeo CJ, et al. Biochemical markers predict morbidity and mortality after pancreaticoduodenectomy. J the American College of Surgeon 2007;204:1029-36.
30. Gleeson EM, Shaikh MF, Shewokis PA, et al. WHippleABACUS, a simple, validated risk score for 30- day mortality after pancreaticoduodenectomy developed using the ACS-NSQIP database. Surgery 2016;160:1279-87.
31. Gibbs J, Cull W, Henderson W,et al. Preoperative Serum Albumin Level as a Predictor of Operative Mortality and Morbidity: Results From the National VA Surgical Risk Study. Arch Surg 1999;134:36-42.
32. Mahmood E, Knio ZO, Mahmood F, et al. Preoperative asymptomatic leukocytosis and postoperative outcome in cardiac surgery patients. PloS one 2017;12:1-11.
33. Lindner HA, Balaban U, Sturm T, et al. An Algorithm for Systemic Inflammatory Response Syndrome Criteria– Based Prediction of Sepsis in a Polytrau