title: Effects of low cardiopulmonary reserve on pancreatic leak following pancreaticoduodenectomy.
abstract: BACKGROUND
  Postoperative complications are increased in patients with reduced cardiopulmonary reserve undergoing major surgery. Pancreatic leak is an important contributor to postoperative complications and death following pancreaticoduodenectomy. The aim of this study was to determine whether reduced cardiopulmonary reserve was a risk factor for pancreatic leak.
  
  
  METHODS
  All patients who underwent pancreaticoduodenectomy between January 2006 and July 2010 were identified from a prospectively held database. Data analysis was restricted to those who underwent cardiopulmonary exercise testing during preoperative assessment. Pancreatic leak was defined as grade A, B or C according to the International Study Group on Pancreatic Fistula definition. An anaerobic threshold (AT) cut-off value of 10·1 ml per kg per min was used to identify patients with reduced cardiopulmonary reserve. Univariable and multivariable analyses were performed to identify other risk factors for pancreatic leak.
  
  
  RESULTS
  Some 67 men and 57 women with a median age of 66 (range 37-82) years were identified. Low AT was significantly associated with pancreatic leak (45 versus 19·2 per cent in patients with greater cardiopulmonary reserve; P = 0·020), postoperative complications (70 versus 38·5 per cent; P = 0·013) and prolonged hospital stay (29·4 versus 17·5 days; P = 0·001). On multivariable analysis, an AT of 10·1 ml per kg per min or less was the only independent factor associated with pancreatic leak.
  
  
  CONCLUSIONS
  Low cardiopulmonary reserve was associated with pancreatic leak following pancreaticoduodenectomy. AT seems a useful tool for stratifying the risk of postoperative complications.
authors: Hepatopancreatobiliary Unit, Freeman Hospital, High Heaton, Newcastle upon Tyne NE7 7DN, UK. f.ausania@googlemail.com
authors: F
authors: F
authors: Ausania
authors: C P
authors: CP
authors: Snowden
authors: J M
authors: JM
authors: Prentis
authors: L R
authors: LR
authors: Holmes
authors: B C
authors: BC
authors: Jaques
authors: S A
authors: SA
authors: White
authors: J J
authors: JJ
authors: French
authors: D M
authors: DM
authors: Manas
authors: R M
authors: RM
authors: Charnley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015308:Anaerobic Threshold / Q000502:physiology*; D057868:Anastomotic Leak / Q000209:etiology*; D005080:Exercise Test; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D011300:Preoperative Care; D011446:Prospective Studies; D012120:Respiration Disorders / Q000150:complications / Q000503:physiopathology*; D012307:Risk Factors