Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 6/2019

01-06-2019 | Original Article

Rates of Serious Complications Estimated by the ACS-NSQIP Surgical Risk Calculator in Predicting Oncologic Outcomes of Patients Treated with Pancreaticoduodenectomy for Pancreatic Head Cancer

Authors: Munseok Choi, Chang Moo Kang, Jae Uk Chong, Ho Kyoung Hwang, Dong Sup Yoon, Woo Jung Lee

Published in: Journal of Gastrointestinal Surgery | Issue 6/2019

Login to get access

Abstract

Background

The purpose of this study was to validate the predictive value of the oncologic outcome in addition to the validation of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator in patients treated with pancreaticoduodenectomy (PD) or pylorus-preserving pancreaticoduodenectomy (PPPD) for pancreatic head cancer.

Methods

From June 2005 to December 2014, 199 patients underwent PD or PPPD for pancreatic head cancer. Medical records were retrospectively reviewed for investigating general patient characteristics and any comorbid diseases. The calculated perioperative complication risks from the ACS NSQIP calculator were compared with observed complication rates. In a propensity score matching analysis, disease-free survival (DFS) and overall survival (OS) were estimated according to calculated severe complication rate (CSCR).

Results

The CSCR > 17.9% (n = 69) and CSCR < 17.9% (n = 130) groups were significantly different considering number of the retrieved lymph nodes (22.95 ± 14.0 vs 18.80 ± 10.1, p = 0.029), histologic grade (p = 0.0235), and incidence of lymphovascular invasion (p = 0.026). The CSCR < 17.9% group had longer DFS (17.0 vs. 11.0 months, p = 0.015), but the OS was similar between the groups (39.0 vs. 23.0 months, p = 0.48). In the 1:2 propensity score analysis, the CSCR < 17.9% group had longer DFS and OS (DFS 26.0 vs. 11.0 months, p = 0.009; OS 44.0 vs. 26.0 months, p = 0.023).

Conclusion

The ACS NSQIP surgical risk calculator predicts surgical risk in patients with pancreatic head cancer who undergo PD or PPPD. Furthermore, this tool can help predict the prognosis of surgically treated pancreatic head cancer.
Literature
1.
Conlon KC, Klimstra DS, Brennan MF. Long-term survival after curative resection for pancreatic ductal adenocarcinoma. Clinicopathologic analysis of 5-year survivors. Ann Surg 1996;223(3):273–279.CrossRefPubMedPubMedCentral
2.
Muller MW, Friess H, Koninger J, Martin D, Wente MN, Hinz U, Ceyhan GO, Blaha P, Kleeff J, Buchler MW. Factors influencing survival after bypass procedures in patients with advanced pancreatic adenocarcinomas. Am J Surg 2008;195(2):221–228.CrossRefPubMed
3.
Yeo CJ, Cameron JL, Sohn TA, Coleman J, Sauter PK, Hruban RH, Pitt HA, Lillemoe KD. Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome. Ann Surg 1999;229(5):613–622; discussion 622-614.CrossRefPubMedPubMedCentral
4.
5.
Greenblatt DY, Kelly KJ, Rajamanickam V, Wan Y, Hanson T, Rettammel R, Winslow ER, Cho CS, Weber SM. Preoperative factors predict perioperative morbidity and mortality after pancreaticoduodenectomy. Ann Surg Oncol 2011;18(8):2126–2135.CrossRefPubMed
6.
Vollmer CM, Jr., Sanchez N, Gondek S, McAuliffe J, Kent TS, Christein JD, Callery MP. A root-cause analysis of mortality following major pancreatectomy. J Gastrointest Surg 2012;16(1):89–102; discussion 102-103.CrossRefPubMed
7.
Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, Sauter PK, Hruban RH, Riall TS, Schulick RD, Choti MA, Lillemoe KD, Yeo CJ. 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg 2006;10(9):1199–1210; discussion 1210-1191.CrossRefPubMed
8.
Howard TJ, Krug JE, Yu J, Zyromski NJ, Schmidt CM, Jacobson LE, Madura JA, Wiebke EA, Lillemoe KD. 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 2006;10(10):1338–1345; discussion 1345-1336.CrossRefPubMed
9.
Kang CM, Kim DH, Choi GH, Kim KS, Choi JS, Lee WJ. Detrimental effect of postoperative complications on oncologic efficacy of R0 pancreatectomy in ductal adenocarcinoma of the pancreas. J Gastrointest Surg 2009;13(5):907–914.CrossRefPubMed
10.
Merkow RP, Bilimoria KY, Tomlinson JS, Paruch JL, Fleming JB, Talamonti MS, Ko CY, Bentrem DJ. Postoperative complications reduce adjuvant chemotherapy use in resectable pancreatic cancer. Ann Surg 2014;260(2):372–377.CrossRefPubMed
11.
Watanabe Y, Nishihara K, Matsumoto S, Okayama T, Abe Y, Nakano T. Effect of postoperative major complications on prognosis after pancreatectomy for pancreatic cancer: a retrospective review. Surg Today 2017;47(5):555–567.CrossRefPubMed
12.
Wu W, He J, Cameron JL, Makary M, Soares K, Ahuja N, Rezaee N, Herman J, Zheng L, Laheru D, Choti MA, Hruban RH, Pawlik TM, Wolfgang CL, Weiss MJ. The impact of postoperative complications on the administration of adjuvant therapy following pancreaticoduodenectomy for adenocarcinoma. Ann Surg Oncol 2014;21(9):2873–2881.CrossRefPubMedPubMedCentral
13.
Adam U, Makowiec F, Riediger H, Schareck WD, Benz S, Hopt UT. Risk factors for complications after pancreatic head resection. Am J Surg 2004;187(2):201–208.CrossRefPubMed
14.
Parikh P, Shiloach M, Cohen ME, Bilimoria KY, Ko CY, Hall BL, Pitt HA. Pancreatectomy risk calculator: an ACS-NSQIP resource. HPB 2010;12(7):488–497.CrossRefPubMedPubMedCentral
15.
Bilimoria KY, Liu Y, Paruch JL, Zhou L, Kmiecik TE, Ko CY, Cohen ME. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg 2013;217(5):833–842 e831–833.CrossRefPubMedPubMedCentral
16.
Liu Y, Cohen ME, Hall BL, Ko CY, Bilimoria KY. Evaluation and Enhancement of Calibration in the American College of Surgeons NSQIP Surgical Risk Calculator. J Am Coll Surg 2016;223(2):231–239.CrossRef
17.
Balzano G, Dugnani E, Crippa S, Scavini M, Pasquale V, Aleotti F, Liberati D, Gandolfi A, Belfiori G, Reni M, Doglioni C, Ruffo G, Marmorale C, Falconi M, Piemonti L. A preoperative score to predict early death after pancreatic cancer resection. Dig Liver Dis 2017;49(9):1050–1056.CrossRefPubMed
18.
19.
Tunes-da-Silva G, Klein JP. Cutpoint selection for discretizing a continuous covariate for generalized estimating equations. Comput Stat Data Anal 2011;55(1):226–235.CrossRefPubMedPubMedCentral
20.
Burgess JR, Smith B, Britt R, Weireter L, Polk T. Predicting Postoperative Complications for Acute Care Surgery Patients Using the ACS NSQIP Surgical Risk Calculator. Am Surg 2017;83(7):733–738.PubMed
21.
Szender JB, Frederick PJ, Eng KH, Akers SN, Lele SB, Odunsi K. Evaluation of the National Surgical Quality Improvement Program Universal Surgical Risk Calculator for a gynecologic oncology service. Int J Gynecol Cancer 2015;25(3):512–520.CrossRefPubMedPubMedCentral
22.
McMillan MT, Allegrini V, Asbun HJ, Ball CG, Bassi C, Beane JD, Behrman SW, Berger AC, Bloomston M, Callery MP, Christein JD, Dickson E, Dixon E, Drebin JA, Fernandez-Del Castillo C, Fisher WE, Fong ZV, Haverick E, Hollis RH, House MG, Hughes SJ, Jamieson NB, Kent TS, Kowalsky SJ, Kunstman JW, Malleo G, McElhany AL, Salem RR, Soares KC, Sprys MH, Valero V III, Watkins AA, Wolfgang CL, Zureikat AH, Vollmer CM, Jr. Incorporation of Procedure-specific Risk Into the ACS-NSQIP Surgical Risk Calculator Improves the Prediction of Morbidity and Mortality After Pancreatoduodenectomy. Ann Surg 2017;265(5):978–986.CrossRefPubMed
23.
Hwang HK, Jung MJ, Lee SH, Kang CM, Lee WJ. Adverse oncologic effects of intraoperative transfusion during pancreatectomy for left-sided pancreatic cancer: the need for strict transfusion policy. J Hepatobiliary Pancreat Sci 2016;23(8):497–507.CrossRefPubMed
24.
Min EK, Chong JU, Hwang HK, Pae SJ, Kang CM, Lee WJ. Negative oncologic impact of poor postoperative pain control in left-sided pancreatic cancer. World J Gastroenterol 2017;23(4):676–686.CrossRefPubMedPubMedCentral
25.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373–383.CrossRef
26.
27.
Kos FT, Yazici O, Civelek B, Seker M, Arik Z, Aksoy S, Uncu D, Ozdemir N, Zengin N. Evaluation of the effect of comorbidity on survival in pancreatic cancer by using “Charlson Comorbidity Index” and “Cumulative Illness Rating Scale”. Wien Klin Wochenschr 2014;126(1–2):36–41.CrossRefPubMed
28.
Asano T, Yamada S, Fujii T, Yabusaki N, Nakayama G, Sugimoto H, Koike M, Fujiwara M, Kodera Y. The Charlson age comorbidity index predicts prognosis in patients with resected pancreatic cancer. Int J Surg 2017;39:169–175.CrossRefPubMed
29.
Mirkin KA, Greenleaf EK, Hollenbeak CS, Wong J. Time to the initiation of adjuvant chemotherapy does not impact survival in patients with resected pancreatic cancer. Cancer 2016;122(19):2979–2987.CrossRefPubMed
30.
Katz MH, Pisters PW, Evans DB, Sun CC, Lee JE, Fleming JB, Vauthey JN, Abdalla EK, Crane CH, Wolff RA, Varadhachary GR, Hwang RF. Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am Coll Surg 2008;206(5):833–846; discussion 846-838.CrossRefPubMedPubMedCentral
Metadata
Title
Rates of Serious Complications Estimated by the ACS-NSQIP Surgical Risk Calculator in Predicting Oncologic Outcomes of Patients Treated with Pancreaticoduodenectomy for Pancreatic Head Cancer
Authors
Munseok Choi
Chang Moo Kang
Jae Uk Chong
Ho Kyoung Hwang
Dong Sup Yoon
Woo Jung Lee
Publication date
01-06-2019
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 6/2019
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-018-4041-1

Other articles of this Issue 6/2019

Journal of Gastrointestinal Surgery 6/2019 Go to the issue

How I do it

Successful Use of the Recanalized Remnant Umbilical Vein as a Patch Graft for Venous Reconstruction in Abdominal Surgery

Multimedia Article

First Experience with Banded Anti-reflux Mucosectomy (ARMS) for GERD: Feasibility, Safety, and Technique (with Video)

GI Image

A Rare, Giant, Cystic, and Cavernous Lymphangioma Originated from the Stomach in a Young Woman

2018 SSAT Plenary Presentation

Sentinel Lymph Node Sampling for Early Gastric Cancer—Preliminary Results of A North American Prospective Study

How I do it

Technical Aspects of Stapled Hepatectomy in Liver Surgery: How We Do It

Original Article

Outcome of Surgical Inspection of the Gallbladder in Relation to Final Pathology