title: Severe postoperative complications adversely affect long-term survival after R1 resection for pancreatic head adenocarcinoma.
abstract: BACKGROUND
  Survival after pancreatic head adenocarcinoma surgery is determined by tumor characteristics, resection margins, and adjuvant chemotherapy. Few studies have analyzed the long-term impact of postoperative morbidity. The aim of the present study was to assess the impact of postoperative complications on long-term survival after pancreaticoduodenectomy for cancer.
  
  
  METHODS
  Of 294 consecutive pancreatectomies performed between January 2000 and July 2011, a total of 101 pancreatic head resections for pancreatic ductal adenocarcinoma were retrospectively analyzed. Postoperative complications were classified on a five-grade validated scale and were correlated with long-term survival. Grade IIIb to IVb complications were defined as severe.
  
  
  RESULTS
  Postoperative mortality and morbidity were 5 and 57 %, respectively. Severe postoperative complications occurred in 16 patients (16 %). Median overall survival was 1.4 years. Significant prognostic factors of survival were the N-stage of the tumor (median survival 3.4 years for N0 vs. 1.3 years for N1, p = 0.018) and R status of the resection (median survival 1.6 years for R0 vs. 1.2 years for R1, p = 0.038). Median survival after severe postoperative complications was decreased from 1.9 to 1.2 years (p = 0.06). Median survival for N0 or N1 tumor or after R0 resection was not influenced by the occurrence and severity of complications, but patients with a R1 resection and severe complications showed a worsened median survival of 0.6 vs. 2.0 years without severe complications (p = 0.0005).
  
  
  CONCLUSIONS
  Postoperative severe morbidity per se had no impact on long-term survival except in patients with R1 tumor resection. These results suggest that severe complications after R1 resection predict poor outcome.
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011 Lausanne, Switzerland. david.petermann@chuv.ch
authors.forename: David
authors.initials: D
authors.lastname: Petermann
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.forename: Markus
authors.initials: M
authors.lastname: Schäfer
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors
references.citation: Arch Surg. 1999 Jan;134(1):81-7
references.pmid: 9927137
references.citation: J Gastrointest Surg. 2009 May;13(5):907-14
references.pmid: 19224295
references.citation: J Clin Oncol. 2012 May 10;30(14):1615-9
references.pmid: 22473157
references.citation: Surgery. 2007 Nov;142(5):761-8
references.pmid: 17981197
references.citation: N Engl J Med. 2004 Mar 18;350(12):1200-10
references.pmid: 15028824
references.citation: Dig Surg. 2005;22(5):353-63
references.pmid: 16293966
references.citation: Eur J Surg Oncol. 2001 Sep;27(6):549-57
references.pmid: 11520088
references.citation: Ann Surg. 2011 Dec;254(6):907-13
references.pmid: 21562405
references.citation: Arch Surg. 2008 Jan;143(1):75-83; discussion 83
references.pmid: 18209156
references.citation: Ann Surg. 2006 Jul;244(1):10-5
references.pmid: 16794383
references.citation: Histopathology. 2009 Sep;55(3):277-83
references.pmid: 19723142
references.citation: Ann Surg. 2007 Aug;246(2):246-53
references.pmid: 17667503
references.citation: Br J Cancer. 2011 Feb 15;104(4):726-34
references.pmid: 21266974
references.citation: Br J Surg. 2007 Nov;94(11):1377-81
references.pmid: 17657717
references.citation: Ann Surg. 2005 Dec;242(6):781-8, discussion 788-90
references.pmid: 16327488
references.citation: Surgery. 2010 Oct;148(4):702-9; discussion 709-10
references.pmid: 20797743
references.citation: Surgery. 2005 Jul;138(1):8-13
references.pmid: 16003309
references.citation: JOP. 2008 Mar 08;9(2):99-132
references.pmid: 18326920
references.citation: J Gastrointest Surg. 2006 Nov;10(9):1199-210; discussion 1210-1
references.pmid: 17114007
references.citation: Ann Surg. 2006 Dec;244(6):931-7; discussion 937-9
references.pmid: 17122618
references.citation: Ann Surg. 2007 Jul;246(1):52-60
references.pmid: 17592291
references.citation: J Gen Intern Med. 2006 Feb;21(2):177-80
references.pmid: 16606377
references.citation: Arch Surg. 2003 Dec;138(12):1310-4; discussion 1315
references.pmid: 14662530
references.citation: J Am Coll Surg. 2004 May;198(5):722-31
references.pmid: 15110805
references.citation: Ann Surg. 2011 Dec;254(6):914-20
references.pmid: 21869677
references.citation: J Surg Oncol. 2000 Apr;73(4):212-8
references.pmid: 10797334
references.citation: J Am Coll Surg. 2006 Jun;202(6):933-7
references.pmid: 16735208
references.citation: Ann Surg. 2002 Sep;236(3):355-66; discussion 366-8
references.pmid: 12192322
references.citation: Ann Surg. 2003 Jan;237(1):74-85
references.pmid: 12496533
references.citation: Ann Surg Oncol. 2012 Mar;19(3):856-63
references.pmid: 21879265
references.citation: Surgery. 2007 Jul;142(1):20-5
references.pmid: 17629996
references.citation: Br J Surg. 2008 Mar;95(3):357-62
references.pmid: 17933001
references.citation: Br J Cancer. 2005 Jan 17;92(1):21-3
references.pmid: 15597096
references.citation: J Gastrointest Surg. 2011 Jun;15(6):1055-62
references.pmid: 21267670
references.citation: J Gastrointest Surg. 2006 Dec;10(10):1338-45; discussion 1345-6
references.pmid: 17175452
references.citation: Ann Surg. 2000 Dec;232(6):786-95
references.pmid: 11088073
references.citation: HPB (Oxford). 2011 Feb;13(2):132-8
references.pmid: 21241431
references.citation: Ann Surg Oncol. 2008 Jun;15(6):1651-60
references.pmid: 18351300
references.citation: Ann Surg. 2002 Aug;236(2):137-48
references.pmid: 12170018
references.citation: J Am Coll Surg. 2007 Oct;205(4 Suppl):S81-6
references.pmid: 17916525