Impact of preoperative asymptomatic renal dysfunction on clinical course after pancreatoduodenectomy.
BACKGROUND
Although recent large-scale clinical studies have shown that preoperative renal insufficiency is associated with increased risk of postoperative complications after pancreatoduodenectomy (PD), it is unknown whether asymptomatic renal dysfunction has an impact on postoperative course after PD.


METHODS
Two hundred and fifty-four patients who underwent PD between 2007 and 2013 were enrolled. Renal function was evaluated by the preoperative estimated glomerular filtration rate (eGFR). Patients were divided into two groups according to the cutoff value of 55 of eGFR.


RESULTS
Thirty-five patients were classified as the low eGFR group, while 219 were classified as the normal group. There were differences between groups in age, comorbidity and pancreatic texture. The incidence of overall postoperative complication, grade B/C pancreatic fistula and severe complication in the low eGFR group was significantly higher than that in the normal group. Multivariate analysis identified low eGFR as an independent risk factor for severe postoperative complications and grade B/C pancreatic fistula after PD. However, there were no differences in mortality and survival between the low and normal eGFR groups.


CONCLUSIONS
We have demonstrated for the first time that preoperative asymptomatic renal dysfunction may be a significant risk factor for severe morbidity and clinically relevant pancreatic fistula after PD.
Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Japan.
Minako
M
Nagai
Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Japan. m-sho@naramed-u.ac.jp.
Masayuki
M
Sho
Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Japan.
Takahiro
T
Akahori
Department of Radiology, Nara Medical University, Kashihara, Nara 634-8522, Japan.
Toshihiro
T
Tanaka
Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Japan.
Shoichi
S
Kinoshita
Department of Radiology, Nara Medical University, Kashihara, Nara 634-8522, Japan.
Hideyuki
H
Nishiofuku
Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Japan.
Satoshi
S
Nishiwada
Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan.
Chiho
C
Ohbayashi
Department of Radiology, Nara Medical University, Kashihara, Nara 634-8522, Japan.
Kimihiko
K
Kichikawa
Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Japan.
Yoshiyuki
Y
Nakajima
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007677:Kidney Function Tests; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D051437:Renal Insufficiency / Q000150:complications / Q000175:diagnosis*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
Pancreatoduodenectomy; Postoperative complication; Prognosis; Renal dysfunction; Surgery