Laparoscopic left pancreatectomy: complication risk score correlates with morbidity and risk for pancreatic fistula.
BACKGROUND
Surgeons are performing laparoscopic left pancreatectomy (LLP) with increasing frequency; however, determinants of perioperative outcome after LLP are not well defined. We evaluated factors contributing to morbidity after LLP.


METHODS
Records from patients undergoing LLP from 2000 to 2008 from nine academic medical centers were evaluated to assess risk factors for perioperative complications. Extent of pancreatic resection was determined by the length of the gross pancreatic specimen. Complications and pancreatic fistula rates were assessed, and a model was developed to identify those at risk of postoperative adverse events.


RESULTS
Among the 219 LLP cases, indications were cystic neoplasms in 122 (56%), solid neoplasms in 83 (38%), and chronic pancreatitis in 14 (6%). Thirty-day morbidity and mortality were 39% and 0, respectively. Major complications occurred in 11%. Pancreatic fistulae were detected in 23%, with clinically important fistulae (International Study Group on Pancreatic Fistula Definition grade B/C) seen in 10%. On multivariate analysis, only greater estimated blood loss (EBL), higher body mass index (BMI), and longer length of resected pancreas were associated with major complications. A complication risk score consisting of 1 point each for BMI >27, pancreatic specimen length >8 cm, or EBL > or =150 mL predicted an increased risk of complications and pancreatic fistulae.


CONCLUSIONS
The risk of major complications after LLP is 11%, with clinically important pancreatic fistulae occurring in 10%. A complication risk score incorporating BMI, extent of pancreatic resection, and EBL correlates with all end points evaluated. The complication risk score should be used when quality outcome measures are evaluated.
Weber
Sharon M
SM
Section of Surgical Oncology, Department of Surgery, H4/752 Clinical Science Center, University of Wisconsin Hospital, Madison, WI, USA. webers@surgery.wisc.edu
Cho
Clifford S
CS
Merchant
Nipun
N
Pinchot
Scott
S
Rettammel
Robert
R
Nakeeb
Atilla
A
Bentrem
David
D
Parikh
Alex
A
Mazo
Ashley E
AE
Martin
Robert C G
RC
Scoggins
Charles R
CR
Ahmad
Syed A
SA
Kim
Hong Jin
HJ
Hamilton
Nicholas
N
Hawkins
William
W
Max Schmidt
C
C
Kooby
David A
DA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000009:adverse effects*; D010181:Pancreatic Cyst / Q000150:complications / Q000601:surgery; D010185:Pancreatic Fistula / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult