Laparoscopic left pancreatectomy

Complication risk score correlates with morbidity and risk for pancreatic fistula

Sharon M. Weber, Clifford S. Cho, Nipun Merchant, Scott Pinchot, Robert Rettammel, Attila Nakeeb, David Bentrem, Alex Parikh, Ashley E. Mazo, Robert C G Martin, Charles R. Scoggins, Syed A. Ahmad, Hong Jin Kim, Nicholas Hamilton, William Hawkins, C. Schmidt, David A. Kooby

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Background. Surgeons are performing laparoscopic left pancreatectomy (LLP) with increasing frequency; however, determinants of perioperative outcome after LLP are not well defined. We evaluated factors contributing to morbidity after LLP. Methods. Records from patients undergoing LLP from 2000 to 2008 from nine academic medical centers were evaluated to assess risk factors for perioperative complications. Extent of pancreatic resection was determined by the length of the gross pancreatic specimen. Complications and pancreatic fistula rates were assessed, and a model was developed to identify those at risk of postoperative adverse events. Results. Among the 219 LLP cases, indications were cystic neoplasms in 122 (56%), solid neoplasms in 83 (38%), and chronic pancreatitis in 14 (6%). Thirty-day morbidity and mortality were 39% and 0, respectively. Major complications occurred in 11%. Pancreatic fistulae were detected in 23%, with clinically important fistulae (International Study Group on Pancreatic Fistula Definition grade B/C) seen in 10%. On multivariate analysis, only greater estimated blood loss (EBL), higher body mass index (BMI), and longer length of resected pancreas were associated with major complications. A complication risk score consisting of 1 point each for BMI >27, pancreatic specimen length >8 cm, or EBL ≥150 mL predicted an increased risk of complications and pancreatic fistulae. Conclusions. The risk of major complications after LLP is 11%, with clinically important pancreatic fistulae occurring in 10%. A complication risk score incorporating BMI, extent of pancreatic resection, and EBL correlates with all end points evaluated. The complication risk score should be used when quality outcome measures are evaluated.

Original languageEnglish
Pages (from-to)2825-2833
Number of pages9
JournalAnnals of Surgical Oncology
Volume16
Issue number10
DOIs
StatePublished - Oct 2009

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Pancreatic Fistula
Pancreatectomy
Morbidity
Body Mass Index
Chronic Pancreatitis
Fistula
Pancreas
Neoplasms
Multivariate Analysis
Outcome Assessment (Health Care)
Mortality

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Laparoscopic left pancreatectomy : Complication risk score correlates with morbidity and risk for pancreatic fistula. / Weber, Sharon M.; Cho, Clifford S.; Merchant, Nipun; Pinchot, Scott; Rettammel, Robert; Nakeeb, Attila; Bentrem, David; Parikh, Alex; Mazo, Ashley E.; Martin, Robert C G; Scoggins, Charles R.; Ahmad, Syed A.; Kim, Hong Jin; Hamilton, Nicholas; Hawkins, William; Schmidt, C.; Kooby, David A.

In: Annals of Surgical Oncology, Vol. 16, No. 10, 10.2009, p. 2825-2833.

Research output: Contribution to journalArticle

Weber, SM, Cho, CS, Merchant, N, Pinchot, S, Rettammel, R, Nakeeb, A, Bentrem, D, Parikh, A, Mazo, AE, Martin, RCG, Scoggins, CR, Ahmad, SA, Kim, HJ, Hamilton, N, Hawkins, W, Schmidt, C & Kooby, DA 2009, 'Laparoscopic left pancreatectomy: Complication risk score correlates with morbidity and risk for pancreatic fistula', Annals of Surgical Oncology, vol. 16, no. 10, pp. 2825-2833. https://doi.org/10.1245/s10434-009-0597-z
Weber, Sharon M. ; Cho, Clifford S. ; Merchant, Nipun ; Pinchot, Scott ; Rettammel, Robert ; Nakeeb, Attila ; Bentrem, David ; Parikh, Alex ; Mazo, Ashley E. ; Martin, Robert C G ; Scoggins, Charles R. ; Ahmad, Syed A. ; Kim, Hong Jin ; Hamilton, Nicholas ; Hawkins, William ; Schmidt, C. ; Kooby, David A. / Laparoscopic left pancreatectomy : Complication risk score correlates with morbidity and risk for pancreatic fistula. In: Annals of Surgical Oncology. 2009 ; Vol. 16, No. 10. pp. 2825-2833.
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abstract = "Background. Surgeons are performing laparoscopic left pancreatectomy (LLP) with increasing frequency; however, determinants of perioperative outcome after LLP are not well defined. We evaluated factors contributing to morbidity after LLP. Methods. Records from patients undergoing LLP from 2000 to 2008 from nine academic medical centers were evaluated to assess risk factors for perioperative complications. Extent of pancreatic resection was determined by the length of the gross pancreatic specimen. Complications and pancreatic fistula rates were assessed, and a model was developed to identify those at risk of postoperative adverse events. Results. Among the 219 LLP cases, indications were cystic neoplasms in 122 (56{\%}), solid neoplasms in 83 (38{\%}), and chronic pancreatitis in 14 (6{\%}). Thirty-day morbidity and mortality were 39{\%} and 0, respectively. Major complications occurred in 11{\%}. Pancreatic fistulae were detected in 23{\%}, with clinically important fistulae (International Study Group on Pancreatic Fistula Definition grade B/C) seen in 10{\%}. On multivariate analysis, only greater estimated blood loss (EBL), higher body mass index (BMI), and longer length of resected pancreas were associated with major complications. A complication risk score consisting of 1 point each for BMI >27, pancreatic specimen length >8 cm, or EBL ≥150 mL predicted an increased risk of complications and pancreatic fistulae. Conclusions. The risk of major complications after LLP is 11{\%}, with clinically important pancreatic fistulae occurring in 10{\%}. A complication risk score incorporating BMI, extent of pancreatic resection, and EBL correlates with all end points evaluated. The complication risk score should be used when quality outcome measures are evaluated.",
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T1 - Laparoscopic left pancreatectomy

T2 - Complication risk score correlates with morbidity and risk for pancreatic fistula

AU - Weber, Sharon M.

AU - Cho, Clifford S.

AU - Merchant, Nipun

AU - Pinchot, Scott

AU - Rettammel, Robert

AU - Nakeeb, Attila

AU - Bentrem, David

AU - Parikh, Alex

AU - Mazo, Ashley E.

AU - Martin, Robert C G

AU - Scoggins, Charles R.

AU - Ahmad, Syed A.

AU - Kim, Hong Jin

AU - Hamilton, Nicholas

AU - Hawkins, William

AU - Schmidt, C.

AU - Kooby, David A.

PY - 2009/10

Y1 - 2009/10

N2 - Background. Surgeons are performing laparoscopic left pancreatectomy (LLP) with increasing frequency; however, determinants of perioperative outcome after LLP are not well defined. We evaluated factors contributing to morbidity after LLP. Methods. Records from patients undergoing LLP from 2000 to 2008 from nine academic medical centers were evaluated to assess risk factors for perioperative complications. Extent of pancreatic resection was determined by the length of the gross pancreatic specimen. Complications and pancreatic fistula rates were assessed, and a model was developed to identify those at risk of postoperative adverse events. Results. Among the 219 LLP cases, indications were cystic neoplasms in 122 (56%), solid neoplasms in 83 (38%), and chronic pancreatitis in 14 (6%). Thirty-day morbidity and mortality were 39% and 0, respectively. Major complications occurred in 11%. Pancreatic fistulae were detected in 23%, with clinically important fistulae (International Study Group on Pancreatic Fistula Definition grade B/C) seen in 10%. On multivariate analysis, only greater estimated blood loss (EBL), higher body mass index (BMI), and longer length of resected pancreas were associated with major complications. A complication risk score consisting of 1 point each for BMI >27, pancreatic specimen length >8 cm, or EBL ≥150 mL predicted an increased risk of complications and pancreatic fistulae. Conclusions. The risk of major complications after LLP is 11%, with clinically important pancreatic fistulae occurring in 10%. A complication risk score incorporating BMI, extent of pancreatic resection, and EBL correlates with all end points evaluated. The complication risk score should be used when quality outcome measures are evaluated.

AB - Background. Surgeons are performing laparoscopic left pancreatectomy (LLP) with increasing frequency; however, determinants of perioperative outcome after LLP are not well defined. We evaluated factors contributing to morbidity after LLP. Methods. Records from patients undergoing LLP from 2000 to 2008 from nine academic medical centers were evaluated to assess risk factors for perioperative complications. Extent of pancreatic resection was determined by the length of the gross pancreatic specimen. Complications and pancreatic fistula rates were assessed, and a model was developed to identify those at risk of postoperative adverse events. Results. Among the 219 LLP cases, indications were cystic neoplasms in 122 (56%), solid neoplasms in 83 (38%), and chronic pancreatitis in 14 (6%). Thirty-day morbidity and mortality were 39% and 0, respectively. Major complications occurred in 11%. Pancreatic fistulae were detected in 23%, with clinically important fistulae (International Study Group on Pancreatic Fistula Definition grade B/C) seen in 10%. On multivariate analysis, only greater estimated blood loss (EBL), higher body mass index (BMI), and longer length of resected pancreas were associated with major complications. A complication risk score consisting of 1 point each for BMI >27, pancreatic specimen length >8 cm, or EBL ≥150 mL predicted an increased risk of complications and pancreatic fistulae. Conclusions. The risk of major complications after LLP is 11%, with clinically important pancreatic fistulae occurring in 10%. A complication risk score incorporating BMI, extent of pancreatic resection, and EBL correlates with all end points evaluated. The complication risk score should be used when quality outcome measures are evaluated.

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DO - 10.1245/s10434-009-0597-z

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EP - 2833

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

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