Preoperative risk factor and risk score analysis to predict critical complications and death following pancreatoduodenetcomy

This is the authors' abstract. We don't add key points for this paper.

Introduction Pancreatoduodenectomy (PD) is the only curative treatment for periampullary malignancies but carries high morbidity. This study aimed to identify pre-operative risk factors associated with serious postoperative complications (CD 4-5) and to evaluate commonly used surgical risk scores. Methods Retrospective single-centre study including 759 consecutive patients with PD performed. Nineteen patients with CD 4-5 were matched to a cohort of CD 3 patients (n = 38) by age, sex and tumour size. Clinical variables were extracted from the national registry for periampullary cancer and through patient chart review. Multiple risk scores were computed and analyzed. Results Patients with CD 4-5 had significantly higher rates og heart failure (26 versus 5%) and peptic ulcer disease (37 versus 11%) as well as elevated CRP and S-creatinine. No significant associations were found regarding pancreatic duct diamter or fistula prediction scores. The NSQIP score from ACS was the that discriminated between groups predicting higher risk. RCRI, SORT, POSSUM, P-POSSUM, A-FRS, BFR and Whipple-ABACUS did not predict higher scores ofr the CD4-5 patients. Several serious comorbidities -particularly renal and hepatic disease- were unrecognised preoperatively. Discussion Serious complications after PD were associated with preoperative heart failure, peptic ulcer disease, elevated creatinine and systemic inflammation. The NSQIP score was the only reliable score identifying patients at risk for CD 4-5 disease. It could be used combined with structured assessment of additional comorbidities not captured by the score- Enhanced clinical screening—particularly for renal, hepatic and heart disease—appears warranted to guide patients and reduce postoperative mortality.