Anouk E J Latenstein1, Lianne Scholten1, Hasan Ahmad Al-Saffar2, Bergthor Björnsson3, Giovanni Butturini4, Giovanni Capretti5, Nikolaos A Chatzizacharias6, Chris Dervenis7, Isabella Frigerio4, Tom K Gallagher8, Silvia Gasteiger9, Asif Halimi2, Knut J Labori10, Greta Montagnini11, Luis Muñoz-Bellvis12, Gennaro Nappo5, Andrej Nikov13, Elizabeth Pando14, Matteo de Pastena11, Jesús M de la Peña-Moral15, Dejan Radenkovic16, Keith J Roberts6, Roberto Salvia11, Francisco Sanchez-Bueno17, Chiara Scandavini2, Mario Serradilla-Martin18, Stefan Stättner9,19, Ales Tomazic20, Martin Varga21, Hana Zavrtanik20, Alessandro Zerbi5, Mert Erkan22, Jörg Kleeff23, Mickaël Lesurtel24, Marc G Besselink1, Jose M Ramia-Angel25. 1. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. 2. HPB-Unit, Department of Upper GI diseases, Karolinska University Hospital, Stockholm, Sweden. 3. Department of Surgery in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. 4. Pancreatic Surgical Unit, Pederzoli Hospital, Peschiera del Garda, Verona, Italy. 5. Pancreatic Surgery Unit, Humanitas Clinical and Research Center-IRCCS and Humanitas University Department of Biomedical Sciences, Rozzano, Pieve Emanuele, Milan, Italy. 6. Department of HPB and Liver Transplant Surgery, Queen Elizabeth Hospital, University Hospitals of Birmingham NHS Trust, Birmingham, UK. 7. Department of General Surgery, Medical School, University of Cyprus, Nicosia, Cyprus. 8. Department of HPB and Transplant Surgery, St. Vincent's University Hospital, Dublin, Ireland. 9. Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria. 10. Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway. 11. General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy. 12. Department of Surgery, University of Salamanca/HospitalUniversitario de Salamanca, Salamanca, Spain. 13. Department of Surgery, Central Military Hospital Prague, Prague, Czech Republic. 14. Department of Hepatopancreatobiliary and Transplant surgery, Hospital Vall d'Hebrón, Barcelona, Spain. 15. Department of Pathology, Hospital Clínico Universitario ''Virgen de la Arrixaca,'' Murcia, Spain. 16. Department of Digestive Surgery, Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia. 17. Department of Surgery, Hospital Cli´nico Universitario ''Virgen de la Arrixaca,''Murcia, Spain. 18. ISS Aragón, Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain. 19. Department of Surgery, Salzkammergut Klinikum, Vöcklabruck, Austria. 20. Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia. 21. Department of Surgery, Paracelsus Medical University, Salzburg, Austria. 22. Department of Surgery, Koc University, Istanbul, Turkey. 23. Department of Visceral, Vascular, and Endocrine Surgery, Martin Luther University, Halle-Wittenberg, Germany. 24. Department of Digestive Surgery & Liver Transplantation, Croix Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France. 25. Department of General and Digestive Surgery, University Hospital of Guadalajara, Guadalajara, Spain.
Abstract
OBJECTIVE: To assess outcomes among patients undergoing total pancreatectomy (TP) including predictors for complications and in-hospital mortality. BACKGROUND: Current studies on TP mostly originate from high-volume centers and span long time periods and therefore may not reflect daily practice. METHODS: This prospective pan-European snapshot study included patients who underwent elective (primary or completion) TP in 43 centers in 16 European countries (June 2018-June 2019). Subgroup analysis included cutoff values for annual volume of pancreatoduodenectomies (<60 vs ≥60).Predictors for major complications and in-hospital mortality were assessed in multivariable logistic regression. RESULTS: In total, 277 patients underwent TP, mostly for malignant disease (73%). Major postoperative complications occurred in 70 patients (25%). Median hospital stay was 12 days (IQR 9-18) and 40 patients were readmitted (15%). In-hospital mortality was 5% and 90-day mortality 8%. In the subgroup analysis, in-hospital mortality was lower in patients operated in centers with ≥60 pancreatoduodenectomies compared <60 (4% vs 10%, P = 0.046). In multivariable analysis, annual volume <60 pancreatoduodenectomies (OR 3.78, 95% CI 1.18-12.16, P = 0.026), age (OR 1.07, 95% CI 1.01-1.14, P = 0.046), and estimated blood loss ≥2L (OR 11.89, 95% CI 2.64-53.61, P = 0.001) were associated with in-hospital mortality. ASA ≥3 (OR 2.87, 95% CI 1.56-5.26, P = 0.001) and estimated blood loss ≥2L (OR 3.52, 95% CI 1.25-9.90, P = 0.017) were associated with major complications. CONCLUSION: This pan-European prospective snapshot study found a 5% inhospital mortality after TP. The identified predictors for mortality, including low-volume centers, age, and increased blood loss, may be used to improve outcomes.
OBJECTIVE: To assess outcomes among patients undergoing total pancreatectomy (TP) including predictors for complications and in-hospital mortality. BACKGROUND: Current studies on TP mostly originate from high-volume centers and span long time periods and therefore may not reflect daily practice. METHODS: This prospective pan-European snapshot study included patients who underwent elective (primary or completion) TP in 43 centers in 16 European countries (June 2018-June 2019). Subgroup analysis included cutoff values for annual volume of pancreatoduodenectomies (<60 vs ≥60).Predictors for major complications and in-hospital mortality were assessed in multivariable logistic regression. RESULTS: In total, 277 patients underwent TP, mostly for malignant disease (73%). Major postoperative complications occurred in 70 patients (25%). Median hospital stay was 12 days (IQR 9-18) and 40 patients were readmitted (15%). In-hospital mortality was 5% and 90-day mortality 8%. In the subgroup analysis, in-hospital mortality was lower in patients operated in centers with ≥60 pancreatoduodenectomies compared <60 (4% vs 10%, P = 0.046). In multivariable analysis, annual volume <60 pancreatoduodenectomies (OR 3.78, 95% CI 1.18-12.16, P = 0.026), age (OR 1.07, 95% CI 1.01-1.14, P = 0.046), and estimated blood loss ≥2L (OR 11.89, 95% CI 2.64-53.61, P = 0.001) were associated with in-hospital mortality. ASA ≥3 (OR 2.87, 95% CI 1.56-5.26, P = 0.001) and estimated blood loss ≥2L (OR 3.52, 95% CI 1.25-9.90, P = 0.017) were associated with major complications. CONCLUSION: This pan-European prospective snapshot study found a 5% inhospital mortality after TP. The identified predictors for mortality, including low-volume centers, age, and increased blood loss, may be used to improve outcomes.