Skip to main content

Advertisement

SpringerLink
Log in

Postoperative Complications Deteriorate Long-Term Outcome in Pancreatic Cancer Patients

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. 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.

    Article  PubMed  CAS  Google Scholar 

  2. Maisonneuve P, Lowenfels AB. Epidemiology of pancreatic cancer: an update. Dig Dis. 2010;28(4–5):645–56.

    Article  PubMed  Google Scholar 

  3. Raimondi S, Maisonneuve P, Lowenfels AB. Epidemiology of pancreatic cancer: an overview. Nat Rev Gastroenterol Hepatol. 2009;6(12):699–708.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. McPhee JT, Hill JS, Whalen GF, et al. Perioperative mortality for pancreatectomy: a national perspective. Ann Surg. 2007;246(2):246–53.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. Birkmeyer JD, Finlayson SR, Tosteson AN, et al. Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy. Surgery. 1999;125(3):250–6.

    Article  PubMed  CAS  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. 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  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. Halloran CM, Ghaneh P, Bosonnet L, et al. Complications of pancreatic cancer resection. Dig Surg. 2002;19(2):138–46.

    Article  PubMed  CAS  Google Scholar 

  17. Seeliger H, Christians S, Angele MK, et al. Risk factors for surgical complications in distal pancreatectomy. Am J Surg. 2010;200(3):311–7.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  PubMed  Google Scholar 

  19. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8-13.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. Welsch T, Buchler MW, Schmidt J. [Surgery for pancreatic cancer]. Z Gastroenterol. 2008;46(12):1393–403.

    Article  PubMed  CAS  Google Scholar 

  22. 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).

    Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

  24. Birkmeyer JD, Sun Y, Wong SL, Stukel TA. Hospital volume and late survival after cancer surgery. Ann Surg. 2007;245(5):777-83.

    Article  PubMed  Google Scholar 

  25. 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).

    Google Scholar 

Download references

Acknowledgement

There was no need of grant support or assistance of others except the authors to complete the manuscript.

Author information

Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, Charité, University Medicine, Berlin, Germany

    Carsten Kamphues MD, Roberta Bova MD, Dorothee Schricke, Michael Hippler-Benscheidt, Daniel Seehofer MD, Matthias Glanemann MD, Peter Neuhaus MD & Marcus Bahra MD

  2. Institute of Pathology, Charité University Hospital, Berlin, Germany

    Frederick Klauschen MD

  3. Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany

    Albrecht Stenzinger MD

Authors
  1. Carsten Kamphues MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roberta Bova MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dorothee Schricke
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Hippler-Benscheidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Frederick Klauschen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Albrecht Stenzinger MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Daniel Seehofer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Matthias Glanemann MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Peter Neuhaus MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Marcus Bahra MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carsten Kamphues MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kamphues, C., Bova, R., Schricke, D. et al. Postoperative Complications Deteriorate Long-Term Outcome in Pancreatic Cancer Patients. Ann Surg Oncol 19, 856–863 (2012). https://doi.org/10.1245/s10434-011-2041-4

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-011-2041-4

Keywords

Search

Navigation