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Erschienen in: Annals of Surgical Oncology 3/2012

01.03.2012 | Pancreatic Tumors

Postoperative Complications Deteriorate Long-Term Outcome in Pancreatic Cancer Patients

verfasst von: Carsten Kamphues, MD, Roberta Bova, MD, Dorothee Schricke, Michael Hippler-Benscheidt, Frederick Klauschen, MD, Albrecht Stenzinger, MD, Daniel Seehofer, MD, Matthias Glanemann, MD, Peter Neuhaus, MD, Marcus Bahra, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 3/2012

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Abstract

Background

Different tumor-specific prognostic factors have been identified in recent years for patients who undergo surgery due to pancreatic head cancer, but the results often were inconsistent. Furthermore, the impact of postoperative complications on patient long-term survival has not been described.

Methods

The long-term outcome of 428 patients who underwent resection of pancreatic head cancer at our center during a 17-year period was evaluated. Perioperative details, including postoperative complications, as well as the follow-up of all patients who left the hospital postoperatively were collected in a prospective database. Univariate and multivariate models were used to identify potential prognostic factors and to evaluate the impact of postoperative complications on long-term survival.

Results

The median survival was 15.5 months with a postoperative complication rate (grade I–IV) of 32.7%. Independent prognostic significance was detected for grading (P < 0.001), R status (P = 0.001), and lymph node status (P = 0.003). The occurrence of severe postoperative complications (grade III–IV) was associated with a significantly shortened survival (16.5 vs. 12.4 months; P = 0.002) and was identified as an independent prognostic factor (P = 0.002).

Conclusions

This large study demonstrates that severe postoperative complications have a strong impact on the long-term survival of patients with pancreatic head cancer comparable to tumor characteristics, such as lymph node status, grading, or R status. As a result, the improvement of surgical procedures in specialized centers might lead to a survival benefit in these patients.
Literatur
1.
Zurück zum Zitat Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893–917.PubMedCrossRef Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893–917.PubMedCrossRef
2.
Zurück zum Zitat Maisonneuve P, Lowenfels AB. Epidemiology of pancreatic cancer: an update. Dig Dis. 2010;28(4–5):645–56.PubMedCrossRef Maisonneuve P, Lowenfels AB. Epidemiology of pancreatic cancer: an update. Dig Dis. 2010;28(4–5):645–56.PubMedCrossRef
3.
Zurück zum Zitat Raimondi S, Maisonneuve P, Lowenfels AB. Epidemiology of pancreatic cancer: an overview. Nat Rev Gastroenterol Hepatol. 2009;6(12):699–708.PubMedCrossRef Raimondi S, Maisonneuve P, Lowenfels AB. Epidemiology of pancreatic cancer: an overview. Nat Rev Gastroenterol Hepatol. 2009;6(12):699–708.PubMedCrossRef
4.
Zurück zum Zitat Fatima J, Schnelldorfer T, Barton J, et al. Pancreatoduodenectomy for ductal adenocarcinoma: implications of positive margin on survival. Arch Surg. 2010;145(2):167–72.PubMedCrossRef Fatima J, Schnelldorfer T, Barton J, et al. Pancreatoduodenectomy for ductal adenocarcinoma: implications of positive margin on survival. Arch Surg. 2010;145(2):167–72.PubMedCrossRef
5.
Zurück zum Zitat Schnelldorfer T, Ware AL, Sarr MG, et al. Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Ann Surg. 2008;247(3):456–62.PubMedCrossRef Schnelldorfer T, Ware AL, Sarr MG, et al. Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Ann Surg. 2008;247(3):456–62.PubMedCrossRef
6.
Zurück zum Zitat Raut CP, Tseng JF, Sun CC, et al. Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Ann Surg. 2007;246(1):52–60.PubMedCrossRef Raut CP, Tseng JF, Sun CC, et al. Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Ann Surg. 2007;246(1):52–60.PubMedCrossRef
7.
Zurück zum Zitat McPhee JT, Hill JS, Whalen GF, et al. Perioperative mortality for pancreatectomy: a national perspective. Ann Surg. 2007;246(2):246–53.PubMedCrossRef McPhee JT, Hill JS, Whalen GF, et al. Perioperative mortality for pancreatectomy: a national perspective. Ann Surg. 2007;246(2):246–53.PubMedCrossRef
8.
Zurück zum Zitat Hill JS, McPhee JT, Whalen GF, et al. In-hospital mortality after pancreatic resection for chronic pancreatitis: population-based estimates from the nationwide inpatient sample. J Am Coll Surg. 2009;209(4):468–76.PubMedCrossRef Hill JS, McPhee JT, Whalen GF, et al. In-hospital mortality after pancreatic resection for chronic pancreatitis: population-based estimates from the nationwide inpatient sample. J Am Coll Surg. 2009;209(4):468–76.PubMedCrossRef
9.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.PubMedCrossRef Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.PubMedCrossRef
10.
Zurück zum Zitat Hill JS, Zhou Z, Simons JP, et al. A simple risk score to predict in-hospital mortality after pancreatic resection for cancer. Ann Surg Oncol. 2010;17(7):1802–7.PubMedCrossRef Hill JS, Zhou Z, Simons JP, et al. A simple risk score to predict in-hospital mortality after pancreatic resection for cancer. Ann Surg Oncol. 2010;17(7):1802–7.PubMedCrossRef
11.
Zurück zum Zitat Kelly KJ, Greenblatt DY, Wan Y, et al. Risk stratification for distal pancreatectomy utilizing ACS-NSQIP: preoperative factors predict morbidity and mortality. J Gastrointest Surg. 2011;15(2):250–61.PubMedCrossRef Kelly KJ, Greenblatt DY, Wan Y, et al. Risk stratification for distal pancreatectomy utilizing ACS-NSQIP: preoperative factors predict morbidity and mortality. J Gastrointest Surg. 2011;15(2):250–61.PubMedCrossRef
12.
Zurück zum Zitat Birkmeyer JD, Finlayson SR, Tosteson AN, et al. Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy. Surgery. 1999;125(3):250–6.PubMedCrossRef Birkmeyer JD, Finlayson SR, Tosteson AN, et al. Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy. Surgery. 1999;125(3):250–6.PubMedCrossRef
13.
Zurück zum Zitat Riediger H, Keck T, Wellner U, et al. The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer. J Gastrointest Surg. 2009;13(7):1337–44.PubMedCrossRef Riediger H, Keck T, Wellner U, et al. The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer. J Gastrointest Surg. 2009;13(7):1337–44.PubMedCrossRef
14.
Zurück zum Zitat Garcea G, Dennison AR, Pattenden CJ, et al. (2008) Survival following curative resection for pancreatic ductal adenocarcinoma A systematic review of the literature. JOP. 9(2):99–132.PubMed Garcea G, Dennison AR, Pattenden CJ, et al. (2008) Survival following curative resection for pancreatic ductal adenocarcinoma A systematic review of the literature. JOP. 9(2):99–132.PubMed
15.
Zurück zum Zitat Jamieson NB, Foulis AK, Oien KA, et al. Positive mobilization margins alone do not influence survival following pancreatico-duodenectomy for pancreatic ductal adenocarcinoma. Ann Surg. 2010;251(6):1003–10.PubMedCrossRef Jamieson NB, Foulis AK, Oien KA, et al. Positive mobilization margins alone do not influence survival following pancreatico-duodenectomy for pancreatic ductal adenocarcinoma. Ann Surg. 2010;251(6):1003–10.PubMedCrossRef
16.
Zurück zum Zitat Halloran CM, Ghaneh P, Bosonnet L, et al. Complications of pancreatic cancer resection. Dig Surg. 2002;19(2):138–46.PubMedCrossRef Halloran CM, Ghaneh P, Bosonnet L, et al. Complications of pancreatic cancer resection. Dig Surg. 2002;19(2):138–46.PubMedCrossRef
17.
Zurück zum Zitat Seeliger H, Christians S, Angele MK, et al. Risk factors for surgical complications in distal pancreatectomy. Am J Surg. 2010;200(3):311–7.PubMedCrossRef Seeliger H, Christians S, Angele MK, et al. Risk factors for surgical complications in distal pancreatectomy. Am J Surg. 2010;200(3):311–7.PubMedCrossRef
18.
Zurück zum Zitat Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142(5):761–8.PubMedCrossRef Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142(5):761–8.PubMedCrossRef
19.
Zurück zum Zitat Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8-13.PubMedCrossRef Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8-13.PubMedCrossRef
20.
Zurück zum Zitat Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142(1):20–5.PubMedCrossRef Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142(1):20–5.PubMedCrossRef
21.
Zurück zum Zitat Welsch T, Buchler MW, Schmidt J. [Surgery for pancreatic cancer]. Z Gastroenterol. 2008;46(12):1393–403.PubMedCrossRef Welsch T, Buchler MW, Schmidt J. [Surgery for pancreatic cancer]. Z Gastroenterol. 2008;46(12):1393–403.PubMedCrossRef
22.
Zurück zum Zitat Khuri SF, Henderson WG, DePalma RG, et al. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005;242(3):326–41 (discussion 341–3). Khuri SF, Henderson WG, DePalma RG, et al. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005;242(3):326–41 (discussion 341–3).
23.
Zurück zum Zitat Kang CM, Kim DH, Choi GH, et al. Detrimental effect of postoperative complications on oncologic efficacy of R0 pancreatectomy in ductal adenocarcinoma of the pancreas. J Gastrointest Surg. 2009;13(5):907–14.PubMedCrossRef Kang CM, Kim DH, Choi GH, et al. Detrimental effect of postoperative complications on oncologic efficacy of R0 pancreatectomy in ductal adenocarcinoma of the pancreas. J Gastrointest Surg. 2009;13(5):907–14.PubMedCrossRef
24.
Zurück zum Zitat Birkmeyer JD, Sun Y, Wong SL, Stukel TA. Hospital volume and late survival after cancer surgery. Ann Surg. 2007;245(5):777-83.PubMedCrossRef Birkmeyer JD, Sun Y, Wong SL, Stukel TA. Hospital volume and late survival after cancer surgery. Ann Surg. 2007;245(5):777-83.PubMedCrossRef
25.
Zurück zum Zitat van Heek NT, Kuhlmann KF, Scholten RJ, et al. Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Ann Surg. 2005;242(6):781–8 (discussion 788–90). van Heek NT, Kuhlmann KF, Scholten RJ, et al. Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Ann Surg. 2005;242(6):781–8 (discussion 788–90).
Metadaten
Titel
Postoperative Complications Deteriorate Long-Term Outcome in Pancreatic Cancer Patients
verfasst von
Carsten Kamphues, MD
Roberta Bova, MD
Dorothee Schricke
Michael Hippler-Benscheidt
Frederick Klauschen, MD
Albrecht Stenzinger, MD
Daniel Seehofer, MD
Matthias Glanemann, MD
Peter Neuhaus, MD
Marcus Bahra, MD
Publikationsdatum
01.03.2012
Verlag
Springer-Verlag
Erschienen in
Annals of Surgical Oncology / Ausgabe 3/2012
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-2041-4

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