Jean Lubrano1, Philippe Bachelier2, François Paye3, Yves Patrice Le Treut4, Laurence Chiche5, Antonio Sa-Cunha6, Olivier Turrini7, Benjamin Menahem8, Guy Launoy9, Jean-Robert Delpero7. 1. Department of Digestive Surgery, University Hospital of Caen, France; NORMANDIE UNIV, UNICAEN, INSERM, ANTICIPE, 14000, Caen, France. Electronic address: lubrano-j@chu-caen.fr. 2. Department of Digestive Surgery, University Hospital of Strasbourg, France. 3. Department of Digestive Surgery, Hospital Saint Antoine, Paris, France. 4. Department of Digestive Surgery, University Hospital of la Timone, Marseille, France. 5. Department of Digestive Surgery, University Hospital of Bordeaux, France. 6. Department of Digestive Surgery, Paul-Brousse Hospital, Paris, France. 7. Department of Digestive Surgery, Paoli-Calmette Institution, Marseille, France. 8. Department of Digestive Surgery, University Hospital of Caen, France; NORMANDIE UNIV, UNICAEN, INSERM, ANTICIPE, 14000, Caen, France. Electronic address: menahem-b@chu-caen.fr. 9. NORMANDIE UNIV, UNICAEN, INSERM, ANTICIPE, 14000, Caen, France.
Abstract
BACKGROUND: Postoperative complications influence overall and disease free survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma is still a matter of debate and controversy. METHODS: The outcome of 942 consecutive patients, from the multicentric study of the French Association of Surgery, between January 2004 and December 2009 was analyzed. Perioperative data, including severe complications (grade III and above), were used in univariate and multivariate analysis to assess their influence on overall and disease free survival. Recurrence and its location were investigated as well. RESULTS: Median overall and disease free survival were 24 and 19 months respectively. Postoperative complications occurred in 444 patients (47%) with 18.3% of severe complications. On multivariate analysis, severe complications, positive lymph node status and R1-R2 resection were independent prognostic factors for both overall and disease free survival. The median overall survival decreased from 25 to 22 months (p = 0.005) and disease free survival from 21 to 16 months (p = 0.02) if severe complications occurred. Severe complications were independent prognostic factor of recurrence (p < 0.001). CONCLUSIONS: Severe complications significantly alter both overall and disease free survival and are an independent factor of recurrence.
BACKGROUND:Postoperative complications influence overall and disease free survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma is still a matter of debate and controversy. METHODS: The outcome of 942 consecutive patients, from the multicentric study of the French Association of Surgery, between January 2004 and December 2009 was analyzed. Perioperative data, including severe complications (grade III and above), were used in univariate and multivariate analysis to assess their influence on overall and disease free survival. Recurrence and its location were investigated as well. RESULTS: Median overall and disease free survival were 24 and 19 months respectively. Postoperative complications occurred in 444 patients (47%) with 18.3% of severe complications. On multivariate analysis, severe complications, positive lymph node status and R1-R2 resection were independent prognostic factors for both overall and disease free survival. The median overall survival decreased from 25 to 22 months (p = 0.005) and disease free survival from 21 to 16 months (p = 0.02) if severe complications occurred. Severe complications were independent prognostic factor of recurrence (p < 0.001). CONCLUSIONS: Severe complications significantly alter both overall and disease free survival and are an independent factor of recurrence.