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Laparoscopic left pancreatectomy: complication risk score correlates with morbidity and risk for pancreatic fistula
Sharon M Weber1, Clifford S Cho, Nipun Merchant
1Section of Surgical Oncology, Department of Surgery, H4/752 Clinical Science Center, University of Wisconsin Hospital, Madison, WI, USA. webers@surgery.wisc.edu
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 > or =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.
Insights
Laparoscopic left pancreatectomy (LLP) has a 11% major complication rate. A risk score using body mass index, specimen length, and blood loss predicts complications and pancreatic fistulae after LLP.
Area of Science:
- Surgery
- Gastroenterology
- Surgical Oncology
Background:
- Laparoscopic left pancreatectomy (LLP) is increasingly performed.
- Determinants of perioperative outcomes after LLP are not well defined.
- This study evaluated factors contributing to morbidity after LLP.
Purpose of the Study:
- To identify risk factors for perioperative complications after LLP.
- To develop a model to predict postoperative adverse events.
Main Methods:
- Retrospective analysis of 219 LLP cases from 2000-2008 across nine academic medical centers.
- Assessment of risk factors for perioperative complications, including pancreatic fistula rates.
- Development of a complication risk score based on body mass index (BMI), pancreatic specimen length, and estimated blood loss (EBL).
Main Results:
- Major complications occurred in 11% of cases, with clinically important pancreatic fistulae in 10%.
- Multivariate analysis identified greater EBL, higher BMI, and longer pancreatic resection length as significant risk factors for major complications.
- A complication risk score (BMI >27, specimen length >8 cm, or EBL >=150 mL) effectively predicted increased risk of complications and pancreatic fistulae.
Conclusions:
- The risk of major complications and clinically important pancreatic fistulae after LLP is significant.
- A complication risk score incorporating BMI, extent of pancreatic resection, and EBL is a valuable tool for predicting outcomes.
- This risk score should be utilized for evaluating quality outcomes in LLP.
