Risk factors for mortality and intra-abdominal complications after pancreatoduodenectomy: multivariate analysis in 300 patients.
BACKGROUND
Studies of risk factors after pancreatoduodenectomy are few: some concern restricted populations and others are based on administrative data.


METHODS
Multicenter clinical data were collected for 300 patients undergoing pancreatoduodenectomy to determine (by univariate and multivariate analysis) preoperative and intraoperative risk factors for mortality and intra-abdominal complications (IACs), including pancreatic fistula. Fourteen factors including the center and volume effect were analyzed.


RESULTS
In univariate analysis, mortality was increased with age 70 years or more, extended resection(s), and volume and center effects. IACs occurred more often with main pancreatic duct diameter of 3 mm or less, normal parenchyma texture, extended resection(s), and the center effect. Pancreatic fistula was more frequent with main pancreatic duct diameter of 3 mm or less, normal parenchyma texture, and the center effect. In multivariate analysis, independent risk factor(s) for mortality were age greater than 70 years (odds ratio [OR], 3; 95% confidence interval [CI], 1.3-8) and extended resection (OR, 5; 95% CI, 1.2-22), risk factors for IACs were extended resection (OR, 5; 95% CI, 1.2-22) and main pancreatic duct diameter of 3 mm or less (OR, 2; 95% CI, 1.1-3), and the risk factor for pancreatic fistula was main pancreatic duct diameter of 3 mm or less (OR, 2.5; 95% CI, 1.2-4.6).


CONCLUSIONS
Age more than 70 years, extended resections, and main pancreatic duct diameter less than 3 mm are independent risk factors that should be considered in indications for and techniques of pancreatoduodenectomy.
Muscari
Fabrice
F
Gastrointestinal Surgery Unit, Hôpital de Rangueil, Toulouse, France.
Suc
Bertrand
B
Kirzin
Sylvain
S
Hay
Jean-Marie
JM
Fourtanier
Gilles
G
Fingerhut
Abe
A
Sastre
Bernard
B
Chipponi
Jacques
J
Fagniez
Pierre-Louis
PL
Radovanovic
Alexandre
A
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D004066:Digestive System Diseases / Q000209:etiology* / Q000401:mortality; D004378:Duodenal Diseases / Q000601:surgery; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery; D005774:Gastrostomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010180:Pancreatectomy / Q000009:adverse effects* / Q000401:mortality; D010182:Pancreatic Diseases / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D012307:Risk Factors; D016019:Survival Analysis