Is an estimation of physiologic ability and surgical stress able to predict operative morbidity after pancreaticoduodenectomy?
BACKGROUND
Mortality rates after pancreaticoduodenectomy (PD) are below 4% in high volume centers, although morbidity rates still remain high. Therefore, it is important to clarify a predictor associated with operative morbidity after PD. The estimation of physiologic ability and surgical stress (E-PASS) score has been developed for comparative audit in general surgical patients.


OBJECTIVE
To evaluate whether E-PASS scoring system could predict the occurrence of complications after PD.


METHODS
We performed retrospective analysis of 69 patients (42.0% pancreatic cancer, 31.9% bile duct cancer, and others) who underwent PD using the E-PASS as a predictor of morbidity. Correlations between the incidence rates of postoperative complications and the preoperative risk score (PRS), surgical stress score (SSS) and comprehensive risk score (CRS) of the E-PASS scoring system were evaluated.


RESULTS
Of the 69 patients 30 (43.5%) experienced a total of 54 postoperative complications. All E-PASS scores, especially PRS and CRS were significantly higher in the patients with postoperative complications than in the patients without complication. The complication rate gradually increased as the PRS, SSS and CRS score increased. Under receiver operating characteristic analysis, if a cut-off point of CRS was 0.75, sensitivity and specificity for the prediction of operative morbidity after PD was 80.0 and 79.5%, respectively. Neoadjuvant chemotherapy and intraoperative radiation therapy (IORT) did not influenced on operative morbidity after PD.


CONCLUSIONS
E-PASS scoring system is useful to evaluate for morbidity after PD. Neoadjuvant chemotherapy and IORT could be adapted without significant extra risk for surgical complication.
Hashimoto
Daisuke
D
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, Kumamoto 860-8556, Japan.
Takamori
Hiroshi
H
Sakamoto
Yasuo
Y
Ikuta
Yoshiaki
Y
Nakahara
Osamu
O
Furuhashi
Satoshi
S
Tanaka
Hiroshi
H
Watanabe
Masayuki
M
Beppu
Toru
T
Hirota
Masahiko
M
Baba
Hideo
H
D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012372:ROC Curve; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013314:Stress, Mechanical; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome