Postoperative complications after pancreatoduodenectomy for malignancy: results from the Recurrence After Whipple’s (RAW) study

TB Russell; PL Labib; J Denson; A Streeter; F Ausania; E Pando; KJ Roberts; A Kausar; VK Mavroeidis; G Marangoni; SC Thomasset; AE Frampton; P Lykoudis; M Maglione; N Alhaboob; H Bari; AM Smith; D Spalding; P Srinivasan; BR Davidson; RH Bhogal; D Croagh; I Dominguez; R Thakkar; D Gomez; MA Silva; P Lapolla; A Mingoli; A Porcu; NS Shah; ZZR Hamady; BA Al-Sarrieh; A Serrablo; S Aroori; PL Labib; TB Russell; A Streeter; J Denson; D Sheridan; M Puckett; MG Browning; F Ausania; C Gonzalez-Abos; E Pando; N Fernandes; EG Moller; CD Taboada; KJ Roberts; R Pande; J Alfarah; A Kausar; S Bandyopadhyay; A Abdelrahim; A Khan; VK Mavroeidis; C Jordan; JRE Rees; G Marangoni; H Blege; SC Thomasset; W Cambridge; O White; AE Frampton; S Blacker; J Blackburn; C Sweeney; P Lykoudis; D Field; M Gouda; M Maglione; R Bellotti; N Alhaboob; HKS Hamid; H Bari; H Ahmed; AM Smith; C Moriarty; L White; M Priestley; K Bode; J Sharp; R Wragg; B Jackson; S Craven; D Spalding; M Fehervari; M Pai; L Alghazawi; null Onifade

doi:10.1093/bjsopen/zrad106

Postoperative complications after pancreatoduodenectomy for malignancy: results from the Recurrence After Whipple’s (RAW) study

TB Russell, PL Labib, J Denson, A Streeter, F Ausania, E Pando, KJ Roberts, A Kausar, VK Mavroeidis, G Marangoni, SC Thomasset, AE Frampton, P Lykoudis, M Maglione, N Alhaboob, H Bari, AM Smith, D Spalding, P Srinivasan, BR DavidsonRH Bhogal, D Croagh, I Dominguez, R Thakkar, D Gomez, MA Silva, P Lapolla, A Mingoli, A Porcu, NS Shah, ZZR Hamady, BA Al-Sarrieh, A Serrablo, S Aroori, PL Labib, TB Russell, A Streeter, J Denson, D Sheridan, M Puckett, MG Browning, F Ausania, C Gonzalez-Abos, E Pando, N Fernandes, EG Moller, CD Taboada, KJ Roberts, R Pande, J Alfarah, A Kausar, S Bandyopadhyay, A Abdelrahim, A Khan, VK Mavroeidis, C Jordan, JRE Rees, G Marangoni, H Blege, SC Thomasset, W Cambridge, O White, AE Frampton, S Blacker, J Blackburn, C Sweeney, P Lykoudis, D Field, M Gouda, M Maglione, R Bellotti, N Alhaboob, HKS Hamid, H Bari, H Ahmed, AM Smith, C Moriarty, L White, M Priestley, K Bode, J Sharp, R Wragg, B Jackson, S Craven, D Spalding, M Fehervari, M Pai, L Alghazawi, Onifade

Peninsula Medical School

Research output: Contribution to journal › Article › peer-review

Abstract

Abstract Background Pancreatoduodenectomy (PD) is associated with significant postoperative morbidity. Surgeons should have a sound understanding of the potential complications for consenting and benchmarking purposes. Furthermore, preoperative identification of high-risk patients can guide patient selection and potentially allow for targeted prehabilitation and/or individualized treatment regimens. Using a large multicentre cohort, this study aimed to calculate the incidence of all PD complications and identify risk factors. Method Data were extracted from the Recurrence After Whipple’s (RAW) study, a retrospective cohort study of PD outcomes (29 centres from 8 countries, 2012–2015). The incidence and severity of all complications was recorded and potential risk factors for morbidity, major morbidity (Clavien–Dindo grade &gt; IIIa), postoperative pancreatic fistula (POPF), post-pancreatectomy haemorrhage (PPH) and 90-day mortality were investigated. Results Among the 1348 included patients, overall morbidity, major morbidity, POPF, PPH and perioperative death affected 53 per cent (n = 720), 17 per cent (n = 228), 8 per cent (n = 108), 6 per cent (n = 84) and 4 per cent (n = 53), respectively. Following multivariable tests, a high BMI (P = 0.007), an ASA grade &gt; II (P &lt; 0.0001) and a classic Whipple approach (P = 0.005) were all associated with increased overall morbidity. In addition, ASA grade &gt; II patients were at increased risk of major morbidity (P &lt; 0.0001), and a raised BMI correlated with a greater risk of POPF (P = 0.001). Conclusion In this multicentre study of PD outcomes, an ASA grade &gt; II was a risk factor for major morbidity and a high BMI was a risk factor for POPF. Patients who are preoperatively identified to be high risk may benefit from targeted prehabilitation or individualized treatment regimens.

Original language	English
Number of pages	0
Journal	BJS Open
Volume	7
Issue number	6
DOIs	https://doi.org/10.1093/bjsopen/zrad106
Publication status	Published - 1 Nov 2023

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10.1093/bjsopen/zrad106

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Russell, TB., Labib, PL., Denson, J., Streeter, A., Ausania, F., Pando, E., Roberts, KJ., Kausar, A., Mavroeidis, VK., Marangoni, G., Thomasset, SC., Frampton, AE., Lykoudis, P., Maglione, M., Alhaboob, N., Bari, H., Smith, AM., Spalding, D., Srinivasan, P., ... Onifade (2023). Postoperative complications after pancreatoduodenectomy for malignancy: results from the Recurrence After Whipple’s (RAW) study. BJS Open, 7(6). https://doi.org/10.1093/bjsopen/zrad106

@article{83779609504249ab8ce964806399b81a,

title = "Postoperative complications after pancreatoduodenectomy for malignancy: results from the Recurrence After Whipple{\textquoteright}s (RAW) study",

abstract = "Abstract Background Pancreatoduodenectomy (PD) is associated with significant postoperative morbidity. Surgeons should have a sound understanding of the potential complications for consenting and benchmarking purposes. Furthermore, preoperative identification of high-risk patients can guide patient selection and potentially allow for targeted prehabilitation and/or individualized treatment regimens. Using a large multicentre cohort, this study aimed to calculate the incidence of all PD complications and identify risk factors. Method Data were extracted from the Recurrence After Whipple{\textquoteright}s (RAW) study, a retrospective cohort study of PD outcomes (29 centres from 8 countries, 2012–2015). The incidence and severity of all complications was recorded and potential risk factors for morbidity, major morbidity (Clavien–Dindo grade > IIIa), postoperative pancreatic fistula (POPF), post-pancreatectomy haemorrhage (PPH) and 90-day mortality were investigated. Results Among the 1348 included patients, overall morbidity, major morbidity, POPF, PPH and perioperative death affected 53 per cent (n = 720), 17 per cent (n = 228), 8 per cent (n = 108), 6 per cent (n = 84) and 4 per cent (n = 53), respectively. Following multivariable tests, a high BMI (P = 0.007), an ASA grade > II (P < 0.0001) and a classic Whipple approach (P = 0.005) were all associated with increased overall morbidity. In addition, ASA grade > II patients were at increased risk of major morbidity (P < 0.0001), and a raised BMI correlated with a greater risk of POPF (P = 0.001). Conclusion In this multicentre study of PD outcomes, an ASA grade > II was a risk factor for major morbidity and a high BMI was a risk factor for POPF. Patients who are preoperatively identified to be high risk may benefit from targeted prehabilitation or individualized treatment regimens. ",

author = "TB Russell and PL Labib and J Denson and A Streeter and F Ausania and E Pando and KJ Roberts and A Kausar and VK Mavroeidis and G Marangoni and SC Thomasset and AE Frampton and P Lykoudis and M Maglione and N Alhaboob and H Bari and AM Smith and D Spalding and P Srinivasan and BR Davidson and RH Bhogal and D Croagh and I Dominguez and R Thakkar and D Gomez and MA Silva and P Lapolla and A Mingoli and A Porcu and NS Shah and ZZR Hamady and BA Al-Sarrieh and A Serrablo and S Aroori and PL Labib and TB Russell and A Streeter and J Denson and D Sheridan and M Puckett and MG Browning and F Ausania and C Gonzalez-Abos and E Pando and N Fernandes and EG Moller and CD Taboada and KJ Roberts and R Pande and J Alfarah and A Kausar and S Bandyopadhyay and A Abdelrahim and A Khan and VK Mavroeidis and C Jordan and JRE Rees and G Marangoni and H Blege and SC Thomasset and W Cambridge and O White and AE Frampton and S Blacker and J Blackburn and C Sweeney and P Lykoudis and D Field and M Gouda and M Maglione and R Bellotti and N Alhaboob and HKS Hamid and H Bari and H Ahmed and AM Smith and C Moriarty and L White and M Priestley and K Bode and J Sharp and R Wragg and B Jackson and S Craven and D Spalding and M Fehervari and M Pai and L Alghazawi and Onifade",

year = "2023",

month = nov,

day = "1",

doi = "10.1093/bjsopen/zrad106",

language = "English",

volume = "7",

journal = "BJS Open",

issn = "2474-9842",

publisher = "Oxford University Press",

number = "6",

}

Russell, TB, Labib, PL, Denson, J, Streeter, A, Ausania, F, Pando, E, Roberts, KJ, Kausar, A, Mavroeidis, VK, Marangoni, G, Thomasset, SC, Frampton, AE, Lykoudis, P, Maglione, M, Alhaboob, N, Bari, H, Smith, AM, Spalding, D, Srinivasan, P, Davidson, BR, Bhogal, RH, Croagh, D, Dominguez, I, Thakkar, R, Gomez, D, Silva, MA, Lapolla, P, Mingoli, A, Porcu, A, Shah, NS, Hamady, ZZR, Al-Sarrieh, BA, Serrablo, A, Aroori, S, Labib, PL, Russell, TB, Streeter, A, Denson, J, Sheridan, D, Puckett, M, Browning, MG, Ausania, F, Gonzalez-Abos, C, Pando, E, Fernandes, N, Moller, EG, Taboada, CD, Roberts, KJ, Pande, R, Alfarah, J, Kausar, A, Bandyopadhyay, S, Abdelrahim, A, Khan, A, Mavroeidis, VK, Jordan, C, Rees, JRE, Marangoni, G, Blege, H, Thomasset, SC, Cambridge, W, White, O, Frampton, AE, Blacker, S, Blackburn, J, Sweeney, C, Lykoudis, P, Field, D, Gouda, M, Maglione, M, Bellotti, R, Alhaboob, N, Hamid, HKS, Bari, H, Ahmed, H, Smith, AM, Moriarty, C, White, L, Priestley, M, Bode, K, Sharp, J, Wragg, R, Jackson, B, Craven, S, Spalding, D, Fehervari, M, Pai, M, Alghazawi, L & Onifade 2023, 'Postoperative complications after pancreatoduodenectomy for malignancy: results from the Recurrence After Whipple’s (RAW) study', BJS Open, vol. 7, no. 6. https://doi.org/10.1093/bjsopen/zrad106

TY - JOUR

T1 - Postoperative complications after pancreatoduodenectomy for malignancy: results from the Recurrence After Whipple’s (RAW) study

AU - Russell, TB

AU - Labib, PL

AU - Denson, J

AU - Streeter, A

AU - Ausania, F

AU - Pando, E

AU - Roberts, KJ

AU - Kausar, A

AU - Mavroeidis, VK

AU - Marangoni, G

AU - Thomasset, SC

AU - Frampton, AE

AU - Lykoudis, P

AU - Maglione, M

AU - Alhaboob, N

AU - Bari, H

AU - Smith, AM

AU - Spalding, D

AU - Srinivasan, P

AU - Davidson, BR

AU - Bhogal, RH

AU - Croagh, D

AU - Dominguez, I

AU - Thakkar, R

AU - Gomez, D

AU - Silva, MA

AU - Lapolla, P

AU - Mingoli, A

AU - Porcu, A

AU - Shah, NS

AU - Hamady, ZZR

AU - Al-Sarrieh, BA

AU - Serrablo, A

AU - Aroori, S

AU - Labib, PL

AU - Russell, TB

AU - Streeter, A

AU - Denson, J

AU - Sheridan, D

AU - Puckett, M

AU - Browning, MG

AU - Ausania, F

AU - Gonzalez-Abos, C

AU - Pando, E

AU - Fernandes, N

AU - Moller, EG

AU - Taboada, CD

AU - Roberts, KJ

AU - Pande, R

AU - Alfarah, J

AU - Kausar, A

AU - Bandyopadhyay, S

AU - Abdelrahim, A

AU - Khan, A

AU - Mavroeidis, VK

AU - Jordan, C

AU - Rees, JRE

AU - Marangoni, G

AU - Blege, H

AU - Thomasset, SC

AU - Cambridge, W

AU - White, O

AU - Frampton, AE

AU - Blacker, S

AU - Blackburn, J

AU - Sweeney, C

AU - Lykoudis, P

AU - Field, D

AU - Gouda, M

AU - Maglione, M

AU - Bellotti, R

AU - Alhaboob, N

AU - Hamid, HKS

AU - Bari, H

AU - Ahmed, H

AU - Smith, AM

AU - Moriarty, C

AU - White, L

AU - Priestley, M

AU - Bode, K

AU - Sharp, J

AU - Wragg, R

AU - Jackson, B

AU - Craven, S

AU - Spalding, D

AU - Fehervari, M

AU - Pai, M

AU - Alghazawi, L

AU - Onifade, null

PY - 2023/11/1

Y1 - 2023/11/1

N2 - Abstract Background Pancreatoduodenectomy (PD) is associated with significant postoperative morbidity. Surgeons should have a sound understanding of the potential complications for consenting and benchmarking purposes. Furthermore, preoperative identification of high-risk patients can guide patient selection and potentially allow for targeted prehabilitation and/or individualized treatment regimens. Using a large multicentre cohort, this study aimed to calculate the incidence of all PD complications and identify risk factors. Method Data were extracted from the Recurrence After Whipple’s (RAW) study, a retrospective cohort study of PD outcomes (29 centres from 8 countries, 2012–2015). The incidence and severity of all complications was recorded and potential risk factors for morbidity, major morbidity (Clavien–Dindo grade > IIIa), postoperative pancreatic fistula (POPF), post-pancreatectomy haemorrhage (PPH) and 90-day mortality were investigated. Results Among the 1348 included patients, overall morbidity, major morbidity, POPF, PPH and perioperative death affected 53 per cent (n = 720), 17 per cent (n = 228), 8 per cent (n = 108), 6 per cent (n = 84) and 4 per cent (n = 53), respectively. Following multivariable tests, a high BMI (P = 0.007), an ASA grade > II (P < 0.0001) and a classic Whipple approach (P = 0.005) were all associated with increased overall morbidity. In addition, ASA grade > II patients were at increased risk of major morbidity (P < 0.0001), and a raised BMI correlated with a greater risk of POPF (P = 0.001). Conclusion In this multicentre study of PD outcomes, an ASA grade > II was a risk factor for major morbidity and a high BMI was a risk factor for POPF. Patients who are preoperatively identified to be high risk may benefit from targeted prehabilitation or individualized treatment regimens.

AB - Abstract Background Pancreatoduodenectomy (PD) is associated with significant postoperative morbidity. Surgeons should have a sound understanding of the potential complications for consenting and benchmarking purposes. Furthermore, preoperative identification of high-risk patients can guide patient selection and potentially allow for targeted prehabilitation and/or individualized treatment regimens. Using a large multicentre cohort, this study aimed to calculate the incidence of all PD complications and identify risk factors. Method Data were extracted from the Recurrence After Whipple’s (RAW) study, a retrospective cohort study of PD outcomes (29 centres from 8 countries, 2012–2015). The incidence and severity of all complications was recorded and potential risk factors for morbidity, major morbidity (Clavien–Dindo grade > IIIa), postoperative pancreatic fistula (POPF), post-pancreatectomy haemorrhage (PPH) and 90-day mortality were investigated. Results Among the 1348 included patients, overall morbidity, major morbidity, POPF, PPH and perioperative death affected 53 per cent (n = 720), 17 per cent (n = 228), 8 per cent (n = 108), 6 per cent (n = 84) and 4 per cent (n = 53), respectively. Following multivariable tests, a high BMI (P = 0.007), an ASA grade > II (P < 0.0001) and a classic Whipple approach (P = 0.005) were all associated with increased overall morbidity. In addition, ASA grade > II patients were at increased risk of major morbidity (P < 0.0001), and a raised BMI correlated with a greater risk of POPF (P = 0.001). Conclusion In this multicentre study of PD outcomes, an ASA grade > II was a risk factor for major morbidity and a high BMI was a risk factor for POPF. Patients who are preoperatively identified to be high risk may benefit from targeted prehabilitation or individualized treatment regimens.

U2 - 10.1093/bjsopen/zrad106

DO - 10.1093/bjsopen/zrad106

M3 - Article

SN - 2474-9842

VL - 7

JO - BJS Open

JF - BJS Open

IS - 6

ER -

Postoperative complications after pancreatoduodenectomy for malignancy: results from the Recurrence After Whipple’s (RAW) study

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