title: Risk factors for mortality and intra-abdominal complications after pancreatoduodenectomy: multivariate analysis in 300 patients.
abstract: 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.
authors.affiliation: Gastrointestinal Surgery Unit, Hôpital de Rangueil, Toulouse, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Muscari
authors.forename: Bertrand
authors.initials: B
authors.lastname: Suc
authors.forename: Sylvain
authors.initials: S
authors.lastname: Kirzin
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Hay
authors.forename: Gilles
authors.initials: G
authors.lastname: Fourtanier
authors.forename: Abe
authors.initials: A
authors.lastname: Fingerhut
authors.forename: Bernard
authors.initials: B
authors.lastname: Sastre
authors.forename: Jacques
authors.initials: J
authors.lastname: Chipponi
authors.forename: Pierre-Louis
authors.initials: PL
authors.lastname: Fagniez
authors.forename: Alexandre
authors.initials: A
authors.lastname: Radovanovic
mesh_terms: 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