Clinical Outcomes after Total Pancreatectomy: A Prospective Multicenter Pan-European Snapshot Study.
Por:
Latenstein AEJ, Scholten L, Al-Saffar HA, Björnsson B, Butturini G, Capretti G, Chatzizacharias NA, Dervenis C, Frigerio I, Gallagher TK, Gasteiger S, Halimi A, Labori KJ, Montagnini G, Muñoz-Bellvis L, Nappo G, Nikov A, Pando E, de Pastena M, de la Peña-Moral JM, Radenkovic D, Roberts KJ, Salvia R, Sanchez-Bueno F, Scandavini C, Serradilla-Martin M, Stättner S, Tomazic A, Varga M, Zavrtanik H, Zerbi A, Erkan M, Kleeff J, Lesurtel M, Besselink MG, Ramia-Angel JM and Scientific, R
Ahead of Print:
9 nov 2020
Resumen:
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 cut-off 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% in-hospital after TP. The identified predictors for mortality, including low-volume centers, age, and increased blood loss, may be used to improve outcomes.
Filiaciones:
Latenstein AEJ:
Department of surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
Scholten L:
Department of surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
Al-Saffar HA:
HPB-unit, Department of Upper GI diseases, Karolinska University Hospital, Stockholm, Sweden
Björnsson B:
Department of Surgery in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
Butturini G:
Pancreatic Surgical Unit, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
Capretti G:
Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS and Humanitas University Department of Biomedical Sciences, Rozzano, Pieve Emanuele, Milan, Italy
Chatzizacharias NA:
Department of HPB and Liver Transplant Surgery, Queen Elizabeth Hospital, University Hospitals of Birmingham NHS Trust, Birmingham, United Kingdom
Dervenis C:
Department of General Surgery, Medical School, University of Cyprus, Nicosia, Cyprus
Frigerio I:
Pancreatic Surgical Unit, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
Gallagher TK:
Department of HPB and Transplant Surgery, St. Vincent's University Hospital, Dublin, Ireland
Gasteiger S:
Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
Halimi A:
HPB-unit, Department of Upper GI diseases, Karolinska University Hospital, Stockholm, Sweden
Labori KJ:
Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
Montagnini G:
General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
Muñoz-Bellvis L:
Department of Surgery, University of Salamanca/Hospital Universitario de Salamanca, Salamanca, Spain
Nappo G:
Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS and Humanitas University Department of Biomedical Sciences, Rozzano, Pieve Emanuele, Milan, Italy
Nikov A:
Department of Surgery, Central Military Hospital Prague, Prague, Czech Republic
Pando E:
Department of Hepatopancreatobiliary and Transplant surgery, Hospital Vall d'Hebrón, Barcelona, Spain
de Pastena M:
General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
de la Peña-Moral JM:
Department of Pathology, Hospital Clínico Universitario "Virgen de la Arrixaca", Murcia, Spain
Radenkovic D:
Department of Digestive Surgery, Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Roberts KJ:
Department of HPB and Liver Transplant Surgery, Queen Elizabeth Hospital, University Hospitals of Birmingham NHS Trust, Birmingham, United Kingdom
Salvia R:
General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
Sanchez-Bueno F:
Department of Surgery, Hospital Clínico Universitario "Virgen de la Arrixaca", Murcia, Spain
Scandavini C:
HPB-unit, Department of Upper GI diseases, Karolinska University Hospital, Stockholm, Sweden
Serradilla-Martin M:
ISS Aragón, Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
Stättner S:
Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
Department of Surgery, Salzkammergut Klinikum, Vöcklabruck, Austria
Tomazic A:
Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
Varga M:
Department of Surgery, Paracelsus Medical University, Salzburg, Austria
Zavrtanik H:
Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
Zerbi A:
Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS and Humanitas University Department of Biomedical Sciences, Rozzano, Pieve Emanuele, Milan, Italy
Erkan M:
Department of Surgery, Koc University, Istanbul, Turkey
Kleeff J:
Department of Visceral, Vascular, and Endocrine Surgery, Martin Luther University, Halle-Wittenberg, Germany
Lesurtel M:
Department of Digestive Surgery & Liver Transplantation, Croix Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
Besselink MG:
Department of surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
:
Department of General and Digestive Surgery, University Hospital of Guadalajara, Guadalajara, Spain
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