title: Postoperative complications and overall survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma.
abstract: BACKGROUND
  Pancreaticoduodenectomy (PD) performed for pancreatic ductal adenocarcinoma (PDA) has a postoperative morbidity of 40-50%. In this study, we analyzed the impact of high grade complications after PD for PDA on overall survival.
  
  
  METHODS
  A total of 596 patients that underwent PD for PDA between 2001 and 2009 were identified from a prospective database. Complications were defined and graded (1-5) as per our Institutional Surgical Secondary Events Program. High grade complications were defined as ≥grade 3. Postoperative mortality (≤90 days) was excluded. Univariate and multivariate analyses were performed to identify factors associated with overall survival.
  
  
  RESULTS
  Median survival was 24 months. Overall complication rate was 51% (301/596). Low grade complications were recorded in 266 patients (45%) and high grade complications in 22% (n = 129). Our 90 day mortality was 3.7% (n = 22). Anastomotic fistula/leak/abscess rate was 14% (n = 82). Multivariate Cox-Regression analysis identified node positivity, estimated blood loss (EBL) >600 ml, length of stay (LOS) >10 days, margin positivity, and vascular procedures as predictors of decreased overall survival (P < 0.05). High grade complications were not associated with overall survival (P = 0.948).
  
  
  CONCLUSIONS
  In this study, the occurrence of high grade postoperative complications was not associated with overall survival.
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York.
authors.forename: Amudhan
authors.initials: A
authors.lastname: Pugalenthi
authors.affiliation: Clinic of Surgical Oncology, Oncology Institute of Vojvodina and University of Novi Sad- Medical Faculty, Novi Sad, Serbia.
authors.forename: Mladjan
authors.initials: M
authors.lastname: Protic
authors.affiliation: Departments of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York.
authors.forename: Mithat
authors.initials: M
authors.lastname: Gonen
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York.
authors.forename: T Peter
authors.initials: TP
authors.lastname: Kingham
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York.
authors.forename: Michael I D'
authors.initials: MI
authors.lastname: Angelica
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York.
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Dematteo
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York.
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York.
authors.forename: William R
authors.initials: WR
authors.lastname: Jarnagin
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Allen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: complications; pancreatic ductal adenocarcinoma; pancreaticoduodenectomy; survival