Impact of Postoperative Complications on Survival of Patients with Pancreatic Carcinoma

Czech version

Authors: J. Kaťuchová; J. Bober; J. Radoňak
Authors‘ workplace: I. chirurgická klinika LF UPJŠ a UNLP Košice, Slovenská republika, prednosta: prof. MUDr. J. Radoňak, CSc
Published in: Rozhl. Chir., 2011, roč. 90, č. 3, s. 174-181.
Category: Monothematic special - Original

Overview

Introduction:
In spite of radical pancreatic resection and adjuvant therapy, the overall 5-year survival rate for patients with pancreatic cancer remains poor, ranging between 5% and 15%, with a median survival of 13 to 17 months.

Material and Methods:
Between January 2000 and December 2009, the prospective study was performed to indentify the presence of postoperative complications and to find their influence on survival rate in pancreatic cancer patients.

Results:
Between January 2000 and December 2009, the radical pancreatic resection was performed for 102 patients suffer from pancreatic cancer, at the I. Department of Surgery University Hospital in Košice.

Pancreatoduodenectomies were performed in Child-Stulhofer modification in 59 patients, Whipple modification was performed in 31 patients, Waugh-Clagett in 2 patients, Traverso-Longmire in 2 patients, distal resection of pancreas was performed in 7 patients and one patient had made total pancreatectomy.

The overall morbidity rate was 30.2% (31 patients) and mortality rate was 3.9% (4 patients). Specific (for pancreatic resection) complications were indentified in 26 patients, 25.3%. Non-specific complications were presented in 5 patients, 4.9%.

Two intraoperative risk factors were found to be significantly associated with pancreatic leakage, small pancreatic duct size and soft texture of the remnant pancreas.

The 5-years survival rate for patients with pancreatic cancer was in 5 patients, 4.9 %, with median survival rate 15 months. In group of patients with postoperative complications median survival rate was 13 months, in group of patients without postoperative complications median survival time was 18 months.

Conclusion:
Long-term survival rate for pancreatic cancer patients is still low. The presence of postoperative complications had negative influence to survival rate in pancreatic cancer patients. Pancreatic leakage is the most afraid complications. Patients with a small pancreatic duct size or a soft pancreatic remnant were at high risk of pancreatic leakage.

Key words:
pancreatic cancer – postoperative complications – pancreatic leakage – survival rate

Sources

1. Alexalis, N., Halloran, C., Raraty, M., et al. Current standards of surgery for pancreatic cancer. Br. J. Surg., 2004; 91: 1410–1427.

2. Beger, H. G., Matsuno, S., Cameron, J. L. Diseases of the pancreas. Current surgical therapy. 1st edition, Berlin Heidelberg New-York, Springer, 2008.

3. Neoptolemos, J. P., Russell, R. C., Bramhall, S., et al: Low mortality following resection for pancreatic and periampullary tumours in 1026 patients: UK survey of specialist pancreatic units. UK Pancreatic cancer group. Br. J. Surg., 1997; 84: 1370–1376.

4. Šácha, M., Sákra, L., Havlíček, F. Současný pohled na problematiku karcinomu pankreatu. Rozhl. Chir., 2000; 79: 123–127.

5. Benassai, G., Mastrorilli, M., Quarto, G., et al. Factors influencing survival after resection for ductal adenocarcinoma of the head of the pancreas. J. Surg. Oncol., 2000; 73: 212–218.

6. Brennan, M. F., Kattan, M. W., Klimstra, D., et al. Prognostic nomogram for patients undergoing resection for adenocarcinoma of the pancreas. Ann. Surg., 2004; 240: 293–298.

7. Cameron, J. L. Current surgical therapy. 8th edition, St. Loius, Mosby, 2004.

8. Bober, J., Blažej, I., Sabo-Nácko, J., et al. Karcinóm pankreasu-diagnostika, chirurgická liečba, výsledky. Folia Medica Cassoviensia Universitas Šafarikiana, 1996; 53: 84–89.

9. Gordon, T. A., Bowmanm, H. M., Tielsch, J. M., et al. Statewide regionalization of pancreaticoduodenectomy and its effect on in-hospital mortality. Ann. Surg., 1998; 228: 71–78.

10. Gouma, D. J., Greenen R. I., Gulik, T., et al. Rates of complications and death after pancreaticoduodenectomy: Risk factors and the impact of hospital volume. Ann. Surg., 2000; 232: 786–795.

11. Ho, W., Heslin, M. J. Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy. Ann. Surg., 2003; 237: 509–514.

12. Yeo, C. J., Cameron, J. L., Lillemoe, K. D., et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2. Randomized control trial evaluating survival, mortality and morbidity. Ann. Surg., 2002; 236: 355–368.

13. Adam, U., Makowiec, F., Riediger, H., et al. Risk factors for complications after panceratic head rescetion. Am. J. Surg., 2004; 187: 201–208.

14. Sohn, T. A., Lillemoe, K. D., Cameron, J. L., et al. Reexploration for periampullary carcinoma. Ann. Surg., 1999; 229: 293–400.

15. Yeo, Ch. J., Cameron, J. L., Maher, M. M., et al. A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann. Surg., 1995; 222: 580–592.

16. Butturini, G., Daskalaki, D., Molinari, E., et al. Pancreatic fistula: definition and current problems. J. Hepatobiliary. Pancreat. Surg., 2008; 15: 247–251.

17. Büchler, M. W., Friess, H., Wagner, M., et al. Pancreatic fistula after panceratic head resection. Br. J. Surg., 2000; 87: 883–889.

18. Büchler, M. W., Wagner, M., Schmied, B., et al. Changes in morbidity after pancreatic resection. Arch. Surg., 2003; 138: 1310–1314.

19. Conlon, K. C., Labow, D., Leung, D., et al. Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic rescetion. Ann. Surg., 2001; 234: 487–494.

20. Bassi, C., Butturuni, G., Molinari, E., et al. Pancreatic fistula rate after pancreatic resection. The importance of definitions. Dig. Surg., 2004; 21: 54–59.

21. Poon, R. T., Lo, S. H., Fong, D., et al. Prevention of pancreatic anastomotic leakage after pancreaticoduodenectomy. Am. J. Surg., 2002; 183: 42–52.

22. Suc, B., Msika, S., Piccinini, M., et al. Octreotide in prevention of intra-abdominal complications following elective pancreatic resection. A prospective, multicenter randomized controlled trial. Arch. Surg., 2004; 139: 288–294.

23. Yeo, C. J., Cameron, J. L., Lillemoe, K. D., et al. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Ann. Surg., 2000; 232: 419–429.

24. Marcus, S. G., Cohen, H., Ranson, J. H. Optimal management of the pancreatic remnant after pancreaticoduodenectomy. Ann. Surg., 1995; 221: 635–648.

25. Hashimoto, N., Ohyanagi, H. Pancreatic juice output and amylase level in the drainage fluid after pancreatoduodenectomy in relation to leakage. Hepato-Gastroenterology, 2002; 49: 553–555.

26. Leffler, J., Polouček, P. Poruchy hojení anastomóz na pankreatu. Rozhl. Chir., 2001; 80: 432–436.

27. Suzuki, Y., Fujino, Y., Tanioka, Y., et al. Selection of pancreaticojejunostomy techniquea according to pancreatic texture and duct size. Arch. Surg., 2002;137: 1044–1047.

28. Tani, M., Onishi, H., Kinoshita, H., et al. The evaluation of duct-to-mucosal pancreaticojejunostomy in pancreaticoduodenectomy. World J. Surg., 2005; 29: 76–79.