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Perioperative outcomes of pancreaticoduodenectomy compared to total pancreatectomy for neoplasia.
- Source :
-
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2014 Mar; Vol. 18 (3), pp. 549-54. Date of Electronic Publication: 2013 Oct 29. - Publication Year :
- 2014
-
Abstract
- Purpose: Total pancreatectomy (TP) eliminates the risk and morbidity of pancreatic leak after pancreaticoduodenectomy (PD). However, TP is a more extensive procedure with guaranteed endocrine and exocrine insufficiency. Previous studies conflict on the net benefit of TP.<br />Methodology: A comparison of patients undergoing non-emergent, curative-intent TP or PD for pancreatic neoplasia using the National Surgical Quality Improvement Project data from 2005-2011 was done. Main outcome measures were mortality and major and minor morbidities.<br />Results: Of the 6,314 (97%) who underwent PD and the 198 (3%) who underwent TP, malignancy was present in 84% of patients. The two groups were comparable at baseline. Mortality was higher after TP (6.1%) than DP (3.1%), p = 0.02. Adjusting for differences on multivariable analysis, TP carried increased mortality (OR 2.64, 95% CI 1.3-5.2, p = 0.005). TP was also associated with increased rates of major morbidity (38 vs. 30%, p = 0.02) and blood transfusion (16 vs. 10%, p = 0.01). Infectious and septic complications occurred equally in both groups.<br />Conclusion: The morbidity of a pancreatic fistula can be eliminated by TP. However, based on our findings, TP is associated with increased major morbidity and mortality. TP cannot be routinely recommended for to reduce perioperative morbidity when pancreaticoduodenectomy is an appropriate surgical option.
- Subjects :
- Abdominal Abscess etiology
Aged
Blood Transfusion statistics & numerical data
Databases, Factual
Female
Humans
Length of Stay
Male
Shock etiology
Surgical Wound Infection etiology
Treatment Outcome
United States epidemiology
Pancreatectomy adverse effects
Pancreatectomy mortality
Pancreatic Neoplasms mortality
Pancreatic Neoplasms surgery
Pancreaticoduodenectomy adverse effects
Pancreaticoduodenectomy mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1873-4626
- Volume :
- 18
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
- Publication Type :
- Academic Journal
- Accession number :
- 24165872
- Full Text :
- https://doi.org/10.1007/s11605-013-2393-0