Long-Term Surgical Complications After Pancreatoduodenectomy: Incidence, Outcomes, and Risk Factors

James A. Brown, Mazen S. Zenati, Richard L. Simmons, Amr I. Al Abbas, Asmita Chopra, Katelyn Smith, Kenneth K.W. Lee, Melissa E. Hogg, Herbert J. Zeh, Alessandro Paniccia, Amer H. Zureikat

Research output: Contribution to journalArticle

Abstract

Background: Long-term complications following pancreatoduodenectomy (PD) can significantly impact quality of life and healthcare utilization. Most reports focus on short-term (within 90 days) PD outcomes; however, the incidence and risk factors for long-term complications (> 90 days) remain to be evaluated. We sought to identify the incidence, outcomes, and risk factors for long-term complications post-PD. Methods: All PD survivors between 2010 and 2017 were identified from a single-institutional database. Long-term complications (> 90 days post-PD and not resulting from cancer recurrence), including biliary stricture, cholangitis, pancreatitis, peptic ulcer, small bowel obstruction, and incisional hernia, were identified. Logistic regression was used to identify perioperative predictors of long-term complications. Results: Of 906 PDs, 628 long-term survivors met criteria for analysis (mean age of 65.3 years, 47% female). Median follow-up and overall survival were 51.1 months (95% CI 47.6, 55.7) and 68.5 months (95% CI 57.9, 81.4), respectively. A total of 198 (31.5%) experienced at least one long-term complication. Complications included incisional hernia (17.7%), biliary stricture or cholangitis (8.0%), pancreatitis (5.7%), small bowel obstruction (4.3%), and peptic ulcer (3.2%). In total, 108 (17.2%) of the complications required an intervention, nearly half of which were surgical. On multivariable analysis, several predictors of long-term complications were identified: obesity (BMI ≥ 30 kg/m2), postoperative wound infection, prolonged index length of stay, readmission (< 90 days), operative approach (open vs. robotic), and pylorus-preservation. Conclusion: Long-term complications occur in nearly a third of PDs and nearly one-fifth of all PDs require re-intervention. Several modifiable predictors of long-term complications were identified.

Original languageEnglish (US)
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Jan 1 2020

Keywords

  • Long-term complications
  • Pancreatoduodenectomy
  • Whipple

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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    Brown, J. A., Zenati, M. S., Simmons, R. L., Al Abbas, A. I., Chopra, A., Smith, K., Lee, K. K. W., Hogg, M. E., Zeh, H. J., Paniccia, A., & Zureikat, A. H. (Accepted/In press). Long-Term Surgical Complications After Pancreatoduodenectomy: Incidence, Outcomes, and Risk Factors. Journal of Gastrointestinal Surgery. https://doi.org/10.1007/s11605-020-04641-3