Top

World Journal of Surgery

Published in:

01-09-2013

Postoperative Complications Influence Prognosis and Recurrence Patterns in Periampullary Cancer

Authors: Jai Young Cho, Ho-Seong Han, Yoo-Seok Yoon, Dae Wook Hwang, Kyuwhan Jung, Young Ki Kim

Published in: World Journal of Surgery | Issue 9/2013

Abstract

Background

The present study was performed to elucidate the influence of postoperative complications on the prognosis and recurrence patterns of periampullary cancer after pancreaticoduodenectomy (PD).

Methods

Clinical data were reviewed from 200 consecutive patients who had periampullary cancer and underwent PD between October 2003 and July 2010, and survival outcomes and recurrence patterns were analyzed. Postoperative complications were classified according to a modification of Clavien’s classification.

Results

Overall, 86 major complications of grade II or higher occurred in 71 patients. The patients were classified into two groups according to the presence of postoperative complications of grade II or higher: group Cx−, absence of complications (n = 129); and group Cx+, presence of complications (n = 71). There were no differences in gender, mean age, tumor node metastasis stage, biliary drainage, type of resection, and radicality between the two groups (P > 0.05). The 3-year overall and disease-free survival rates of the group Cx+ patients (31.0 and 22.3 %, respectively) were significantly lower than those of the group Cx− patients (49.0 and 40.0 %; P = 0.003 and 0.002, respectively). The multivariate analysis showed that postoperative complications (P = 0.001; RR = 1.887; 95 % confidence interval [CI] 1.278–2.785), a T stage of T3 or T4 (P = 0.001; RR = 2.503; 95 % CI 1.441–4.346), positive node metastasis (P = 0.001; RR = 2.093; 95 % CI, 1.378–3.179), R1 or R2 resection (P = 0.023; RR = 1.863; 95 % CI 1.090–3.187), and angiolymphatic invasion (P = 0.013; RR = 1.676; 95 % CI 1.117–2.513) were independent prognostic factors for disease-free survival. Regarding recurrence patterns, group Cx+ patients exhibited more distant recurrences than did group Cx− patients (P = 0.025).

Conclusions

Postoperative complications affect prognosis and recurrence patterns in patients with periampullary cancer after PD.

Hatzaras I, George N, Muscarella P et al (2010) Predictors of survival in periampullary cancers following pancreaticoduodenectomy. Ann Surg Oncol 17:991–997PubMedCrossRef

Balcom JHT, Rattner DW, Warshaw AL et al (2001) Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg 136:391–398PubMedCrossRef

Yeo CJ, Cameron JL, Maher MM et al (1995) A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg 222:580–588 discussion 588–592PubMed

Buchler MW, Friess H, Wagner M et al (2000) Pancreatic fistula after pancreatic head resection. Br J Surg 87:883–889PubMedCrossRef

Sato N, Yamaguchi K, Chijiiwa K et al (1998) Risk analysis of pancreatic fistula after pancreatic head resection. Arch Surg 133:1094–1098PubMedCrossRef

Khuri SF, Henderson WG, DePalma RG et al (2005) Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg 242:326–341 discussion 341–343PubMed

Law WL, Choi HK, Lee YM, Ho JW (2007) The impact of postoperative complications on long-term outcomes following curative resection for colorectal cancer. Ann Surg Oncol 14:2559–2566PubMedCrossRef

Crozier JE, McKee RF, McArdle CS et al (2007) Preoperative but not postoperative systemic inflammatory response correlates with survival in colorectal cancer. Br J Surg 94:1028–1032PubMedCrossRef

Jamieson GG, Thompson SK (2009) Detection of lymph node metastases in oesophageal cancer. Br J Surg 96:21–25PubMedCrossRef

10.

Murri AM, Hilmy M, Bell J et al (2008) The relationship between the systemic inflammatory response, tumour proliferative activity, T-lymphocytic and macrophage infiltration, microvessel density and survival in patients with primary operable breast cancer. Br J Cancer 99:1013–1019PubMedCrossRef

11.

Han HS, Cho JY, Yoon YS et al (2011) Preoperative inflammation is a prognostic factor for gallbladder carcinoma. Br J Surg 98:111–116PubMedCrossRef

12.

Cho JY, Han HS, Yoon YS et al (2012) Preoperative cholangitis and metastatic lymph node have negative impact on survival after resection of extrahepatic bile duct cancer. World J Surg 36:1842–1847. doi:10.1007/s00268-012-1594-0 PubMedCrossRef

13.

Clavien PA, Camargo CA Jr, Croxford R et al (1994) Definition and classification of negative outcomes in solid organ transplantation. Application in liver transplantation. Ann Surg 220:109–120PubMedCrossRef

14.

Cho JY, Suh KS, Kwon CH et al (2006) Outcome of donors with a remnant liver volume of less than 35 % after right hepatectomy. Liver Transpl 12:201–206PubMedCrossRef

15.

Cho JY, Suh KS, Kwon CH et al (2006) Mild hepatic steatosis is not a major risk factor for hepatectomy and regenerative power is not impaired. Surgery 139:508–515PubMedCrossRef

16.

Yi NJ, Suh KS, Cho JY et al (2007) Three-quarters of right liver donors experienced postoperative complications. Liver Transpl 13:797–806PubMedCrossRef

17.

Katz MH, Wang H, Balachandran A et al (2011) Effect of neoadjuvant chemoradiation and surgical technique on recurrence of localized pancreatic cancer. J Gastrointest Surg 16:68–79PubMedCrossRef

18.

Hur S, Yoon CJ, Kang SG et al (2011) Transcatheter arterial embolization of gastroduodenal artery stump pseudoaneurysms after pancreaticoduodenectomy: safety and efficacy of two embolization techniques. J Vasc Interv Radiol 22:294–301PubMedCrossRef

19.

Wagner M, Redaelli C, Lietz M et al (2004) Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg 91:494–586CrossRef

20.

Schafer M, Mullhaupt B, Clavien PA (2002) Evidence-based pancreatic head resection for pancreatic cancer and chronic pancreatitis. Ann Surg 236:137–148PubMedCrossRef

21.

Nitecki SS, Sarr MG, Colby TV et al (1995) Long-term survival after resection for ductal adenocarcinoma of the pancreas. Is it really improving? Ann Surg 221:59–66PubMedCrossRef

22.

Han SS, Jang JY, Kim SW et al (2006) Analysis of long-term survivors after surgical resection for pancreatic cancer. Pancreas 32:271–275PubMedCrossRef

23.

Yeo CJ, Sohn TA, Cameron JL et al (1998) Periampullary adenocarcinoma: analysis of 5-year survivors. Ann Surg 227:821–831PubMedCrossRef

24.

Yeo CJ, Cameron JL, Sohn TA et al (1999) Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome. Ann Surg 229:613–622 discussion 622–624PubMedCrossRef

25.

Riall TS, Cameron JL, Lillemoe KD et al (2006) Resected periampullary adenocarcinoma: 5-year survivors and their 6- to 10-year follow-up. Surgery 140:764–772PubMedCrossRef

26.

Nakao A, Harada A, Nonami T et al (1995) Lymph node metastases in carcinoma of the head of the pancreas region. Br J Surg 82:399–402PubMedCrossRef

27.

Chan C, Herrera MF, de la Garza L et al (1995) Clinical behavior and prognostic factors of periampullary adenocarcinoma. Ann Surg 222:632–637PubMedCrossRef

28.

Howard TJ, Krug JE, Yu J et al (2006) A margin-negative R0 resection accomplished with minimal postoperative complications is the surgeon’s contribution to long-term survival in pancreatic cancer. J Gastrointest Surg 10:1338–1345 discussion 1345–1346PubMedCrossRef

29.

Kang CM, Kim DH, Choi GH et al (2009) Detrimental effect of postoperative complications on oncologic efficacy of R0 pancreatectomy in ductal adenocarcinoma of the pancreas. J Gastrointest Surg 13:907–914PubMedCrossRef

30.

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

31.

Murthy BL, Thomson CS, Dodwell D et al (2007) Postoperative wound complications and systemic recurrence in breast cancer. Br J Cancer 97:1211–1217PubMedCrossRef

32.

Kressner U, Graf W, Mahteme H et al (2002) Septic complications and prognosis after surgery for rectal cancer. Dis Colon Rectum 45:316–321PubMedCrossRef

33.

Balkwill F, Mantovani A (2001) Inflammation and cancer: back to Virchow? Lancet 357:539–545PubMedCrossRef

34.

Abramovitch R, Marikovsky M, Meir G et al (1999) Stimulation of tumour growth by wound-derived growth factors. Br J Cancer 79:1392–1398PubMedCrossRef

35.

Menetrier-Caux C, Montmain G, Dieu MC et al (1998) Inhibition of the differentiation of dendritic cells from CD34(+) progenitors by tumor cells: role of interleukin-6 and macrophage colony-stimulating factor. Blood 92:4778–4791PubMed

36.

Bogden AE, Moreau JP, Eden PA (1997) Proliferative response of human and animal tumours to surgical wounding of normal tissues: onset, duration and inhibition. Br J Cancer 75:1021–1027PubMedCrossRef

37.

Raa ST, Oosterling SJ, van der Kaaij NP et al (2005) Surgery promotes implantation of disseminated tumor cells, but does not increase growth of tumor cell clusters. J Surg Oncol 92:124–129PubMedCrossRef

38.

Jacobi CA, Ordemann J, Zieren HU et al (1998) Increased systemic inflammation after laparotomy vs laparoscopy in an animal model of peritonitis. Arch Surg 133:258–262PubMedCrossRef

39.

van den Tol PM, van Rossen EE, van Eijck CH et al (1998) Reduction of peritoneal trauma by using nonsurgical gauze leads to less implantation metastasis of spilled tumor cells. Ann Surg 227:242–248PubMedCrossRef

40.

van den Tol MP, ten Raa S, van Grevenstein WM et al (2007) The post-surgical inflammatory response provokes enhanced tumour recurrence: a crucial role for neutrophils. Dig Surg 24:388–394PubMedCrossRef

Title: Postoperative Complications Influence Prognosis and Recurrence Patterns in Periampullary Cancer
Authors: Jai Young Cho
Ho-Seong Han
Yoo-Seok Yoon
Dae Wook Hwang
Kyuwhan Jung
Young Ki Kim
Publication date: 01-09-2013
Publisher: Springer US
Published in: World Journal of Surgery / Issue 9/2013
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-013-2106-6

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Postoperative Complications Influence Prognosis and Recurrence Patterns in Periampullary Cancer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2013

Hepatectomy for Huge Hepatocellular Carcinoma: Single Institute’s Experience

First Steps in the Management of Pericardial Effusion: Who Was First to Relieve the Pericardial Sac—Larrey or Romero?

Inherent Difficulties of Measuring the Burden of Surgical Disease in Resource-Poor Settings

Undergraduate Surgery Clerkship and the Choice of Surgery as a Career: Perspective from a Developing Country

Preservation of the Celiac Branch of the Vagus Nerve during Laparoscopy-assisted Distal Gastrectomy: Impact on Postprandial Changes in Ghrelin Secretion

Physical Examination: The First Step in Sophisticated Diagnostic Path of Breast Cancer