The effect of vascular reconstruction on early postoperative outcomes after pancreaticoduodenectomy: An analysis of the American College of Surgeons National Surgical Quality Improvement Program database.
Castleberry, AW; White, RR; De La Fuente, SG; Tyler, DS; Pappas, TN; Scarborough, JE
Published in: Journal of Clinical Oncology
153 Background: Several single-center reports have been published suggesting that vascular reconstruction (VR) during pancreaticoduodenectomy (PD) allows an acceptable oncologic outcome in patients with pancreatic adenocarcinoma without affecting early postoperative mortality or morbidity. The objective of our study was to review the outcomes associated with VR during PD using a large multicenter data source. Methods: A retrospective cohort analysis was performed using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files for 2005-2009. All patients undergoing PD for a postoperative diagnosis of malignant neoplasm of the pancreas were included. Forward stepwise multivariate regression analysis was used to determine the association between VR during PD and 30-day postoperative mortality and morbidity after adjusting for patient demographics and comorbidities. Results: 3582 patients were included for analysis, 281 (7.8%) of whom underwent VR during PD. VR during PD was associated with significantly greater risk-adjusted 30-day postoperative mortality (5.7% with VR vs. 2.9% without VR, Adjusted Odds Ratio (AOR) 2.1, 95% CI 1.22-3.73, p = 0.008) and overall morbidity (39.9% with VR vs. 33.3% without VR, AOR 1.36, 95% CI 1.05-1.75, p = 0.02). Patients undergoing VR required significantly longer operative times, and were more likely to require intraoperative transfusion or early reoperation, than patients not undergoing VR during PD. There was no significant difference in risk-adjusted postoperative mortality or morbidity between those patients undergoing VR by the primary surgical team versus those patients undergoing VR by a vascular surgical team. Conclusions: Contrary to the findings of several previously published single-center analyses, data from ACS-NSQIP suggests that VR significantly increases the risk of 30-day postoperative death or complications after PD. Patients who may require VR during PD will likely benefit from referral to centers with sufficient experience with this procedure.
