Introduction
Methods
Study design
Surgical procedure
Postoperative management
Postoperative complications and definitions
Mortality
Analysis of risk factors for CR-IC development
The impact of CR-IC on Clavien-Dindo ≥ III, intensive care unit, and mortality
Statistical analysis
Ethical considerations
Results
All population | Without CR- IC | With CR- IC | p-value | |
---|---|---|---|---|
N = 140 | n = 93 | n = 47 | ||
Age, years (median, range) | 66.5 (15–83) | 64 (15–83) | 69 (43–81) | 0.074 |
Male sex, n(%) | 77(55%) | 49(52.7%) | 28(59.6%) | 0.439 |
Pathology, n(%) | 0.772 | |||
Pancreatic adenocarcinoma | 70(50%) | 49(52.7%) | 21(44.7%) | |
Ampullary adenocarcinoma | 16(11.4%) | 10(10–8%) | 6(12.8%) | |
Neuroendocrine tumour | 12(8.6%) | 8(8.6%) | 4(8.5%) | |
Squamous carcinoma | 6(4.3%) | 2(2.2%) | 4(8.5%) | |
Chronic pancreatitis | 9(6.4%) | 8(8.6%) | 1(2.1%) | |
Cholangiocarcinoma | 6(4.3%) | 4(4.3%) | 2(4.3%) | |
Other benign pancreatic disease | 10(7.1%) | 6(6.5%) | 4(8.5%) | |
Other malignancy | 5(3.6%) | 3(3.2%) | 2(4.3%) | |
IPMN | 2(1.4%) | 1(1.1%) | 1(2.1%) | |
GIST tumour | 2(1.4%) | 1(1.1%) | 1(2.1%) | |
Duodenal cancer | 2(1.4%) | 1(1.1%) | 1(2.1%) | |
Tumoral staging in cancer | 0.072 | |||
Stage Tis | 3(2.7%) | 1(1.4%) | 2(5.3%) | |
StageIA | 9(8.0%) | 2(2.7%) | 7(18.4%) | |
StageIB | 14(12.5%) | 9(12.2%) | 5(13.2%) | |
StagIIA | 22(19.6%) | 14(18.9%) | 8(21.1%) | |
StageIIB | 51(45.5%) | 38(18.9%) | 13(34.2%) | |
StageIII | 8(7.1%) | 6(8.1%) | 2(5.3%) | |
Stage IV | 5(4.5%) | 4(5.4%) | 1(2.6%) | |
Pre-existing conditions, n(%) | ||||
Smoking, n(%) | 33(23.6%) | 21(22.6%) | 12(25.5%) | 0.698 |
Alcohol, n(%) | 13(9.3%) | 10(10.8%) | 3(6.4%) | 0.305* |
High blood pressure, n(%) | 46(32.9%) | 30(32.3%) | 16(34%) | 0.832 |
Diabetes mellitus, n(%) | 21(15%) | 13(14%) | 8(17%) | 0.634 |
Cardiovascular disease, n(%) | 12(8.6%) | 6(6.5%) | 6(12.8%) | 0.173* |
Renal chronic disease, n(%) | 0 | 0 | 0 | |
Respiratory chronic disease, n(%) | 9(6.4%) | 3(3.2%) | 6(12.8%) | 0.039* |
Dyslipemia, n(%) | 40(28.6%) | 24(25.8%) | 16(34%) | 0.308 |
Personal history of cancer (%) | 24(17.1%) | 17(18.3%) | 7(14.9%) | 0.616 |
All population | Without CR- CI | With CR-CI | p-value | |
---|---|---|---|---|
N = 140 | n = 93 | n = 47 | ||
Pancreatic fistula (POPF) | < 0.001 | |||
No pancreatic fistula, n(%) | 100(71.4%) | 84(90.3%) | 16(34%) | |
Biochemical leak, n(%) | 6(4.3%) | 6(6.5%) | 0 | |
Grade B POPF, n(%) | 23(16.4%) | 3(3.2%) | 20(42.6%) | |
Grade C POPF, n(%) | 11(7.9%) | 0 | 11(23.4%) | |
Clinically relevant POPF (B-C), n(%) | 34(24.3%) | 3(3.2%) | 31(66%) | < 0.001 |
Delayed gastric empty, n(%) | 29(20.7%) | 11(11.8%) | 18(38.3%) | < 0.001 |
Bile leak, n(%) | 10(7.1%) | 3(3.2%) | 7(14.9%) | 0.017* |
Enterocutaneous fistula, n(%) | 3(2.1%) | 0 | 3(6.4%) | 0.036* |
Post-operative haemorrhage, n(%) | 16(11.4%) | 5(5.4%) | 11(23.4%) | 0.002 |
Intraoperative transfusions, median ± SD | 0 (0–1) | 0 (1–1) | 0 (0–1) | 0.759 |
Postoperative transfusions, median ± SD | 0 (0–22) | 0 (0–6) | 1 (0–22) | < 0.001 |
Collections requiring percutaneous drainage, n(%) | 4(2.9%) | 0 | 7(14.9%) | < 0.001* |
Collections requiring surgical debridement, n(%) | 7(5.0%) | 0 | 4(8.5%) | < 0.001* |
Positive cultures in drainages, n(%) | 37(26.4%) | 4(4.3%) | 33(70.2%) | < 0.001 |
Clavien-Dindo grade of complications, n(%) | < 0.001 | |||
No complications | 48(34.3%) | 48(51–6%) | 0 | |
I | 7(5%) | 7(7.5%) | 0 | |
II | 59(42.1%) | 31(33.3%) | 28(59.6%) | |
III | 12(8.6%) | 4(4.3%) | 8(17%) | |
IV | 10(7.1%) | 1(1.1%) | 9(19.1%) | |
V | 4(2.9%) | 2(2.2%) | 2(4.3%) | |
Clavien-Dindo ≥ grade III, n(%) | 26(18.6%) | 7(7.5%) | 19(40.4%) | < 0.001 |
Hospital length stay, days (median, range) | 17 (8–189) | 13 (8–189) | 32 (10–184) | < 0.001 |
ICU admission, n(%) | 16(11.4%) | 4(4.3%) | 12(25.5%) | < 0.001 |
Mortality, n(%) | 4(2.9%) | 2(2.2%) | 2(4.3%) | 0.412* |
Drain removal
Risk factors related to CR-CI and CR-POPF
Clavien-Dindo ≥ III complications
Complications related to Clavien-Dindo III complications | ICU admission | |||||||
---|---|---|---|---|---|---|---|---|
No (n = 114) | Yes (n = 26) | p-value | OR (CI95%) | No (n = 114) | Yes (n = 26) | p-value | OR (CI95%) | |
Events | ||||||||
CR-IC in general | 28(24.6%) | 19(73.1%) | < 0.001 | 8.3 (3.2–21.9) | 35(28.2%) | 12(75%) | < 0.001 | 7.6 (2.3–25.3) |
CR-POPF (grade B-C) | 18(15.8%) | 16(61.5%) | < 0.001 | 8.5 (3.3–21.8) | 23(18.5%) | 11(68.8%) | < 0.001 | 9.7 (3.0–30.5) |
CR-POPF + IC | 15(48.4%) | 16(61.5%) | < 0.001 | 10.6 (4.0–27.5) | 20(16.1%) | 11(68.8%) | < 0.001 | 11.4 (3.6–36.5) |
Delayed gastric emptying | 20(17.5%) | 9(34.6%) | 0.053 | – | 24(19.4%) | 5(31.3%) | 0.213 | – |
Delayed gastric emptying + IC | 11(9.6%) | 6(23.1%) | 0.660 | – | 13(10.5%) | 4(25%) | 0,107 | – |
Hemorraghe in general | 8(7%) | 8(30.8%) | 0.002 | 5.9 (2.0–17.7) | 11(8.9%) | 5(31.3%) | 0.021 | 4.7 (1.4–15.9) |
Hemorraghe + IC | 3(2.6%) | 8(30.8%) | < 0.001 | 16.4 (4.0–67.8) | 6(4.8%) | 5(31.3%) | 0,003 | 8.9 (2.3–34) |
Bile leak | 2(1.8%) | 8(30.8%) | < 0.001 | 24.9 (4.9–126.7) | 5(4%) | 5(31.3%) | 0.002 | 10.8 (2.7–43.2) |
Bile leak + IC | 1(0.9%) | 6(23.1%) | < 0.001 | 33.9 (3.8–296.8) | 3(2.4%) | 4(25.0%) | 0,003 | 13.4 (2.7–62.7) |
Model 1 (*) | OR (CI95%) | p |
Clinically relevant intraabdominal collections-POPF related | 10.6 (3.90–28.7) | < 0.001 |
Model 2 (*) | OR (CI95%) | p |
Cardiovascular disease | 5.4 (1.06–27.18) | 0.042 |
Clinically relevant intraabdominal collections-POPF related | 10.6 (3.36–33.65) | < 0.001 |
Bile leak | 21.8 (3.53–134.61) | < 0.001 |