Detailed Abstract
[Poster Presentation 6 - Biliary & Pancreas (Biliary Disease/Surgery)]
[BP PP 6-S3] Risk Factor for Pancreatic Fistula And Posthepatectomy Liver Failure in Major HPD
Takashi MIZUNO 1, Shunsuke ONOE 1, Nobuyuki WATANABE 1, Shoji KAWAKATSU 1, Tomoki EBATA 1
1 Department of Surgical Oncology, Division of Surgery, Nagoya Graduate School of Medicine, JAPAN
Background : Major hepatectomy with pancreatoduodenectomy (major HPD) is indicated for extensively infiltrating cholangiocarcinoma and locally advanced gallbladder cancer. However, is still associated with high rates of postoperative complications and mortality.
Methods : We retrospectively analyzed cases of pancreaticoduodenectomy combined with major hepatectomy between 2002 and 2020. Risk factors for grade B/C postoperative pancreatic fistula and grade B/C posthepatectomy liver failure were examined.
Results : Among 176 study patients, PHLF and POPF occurred in 86 (49%), and 128 cases (73%), respectively. The incidence of POPF was associated with the incidence of PHLF (P=0.001). Postoperative mortality occurred in 11 cases (6%), all of which were cases with both POPF and PHLF. Multivariable analysis identified Body Mass Index >22 (Odds ratio, 5.127; 95% CI, 2.085-12.61; P<0.001), main pancreatic duct diameter <5mm (Odds ratio, 6.051; 95% CI, 1.586-23.09; P=0.008), and time to specimen taken-out >9 hours (Odds ratio, 7.040; 95% CI, 1.454-34.07; P=0.014), as independent factors for POPF. POPF (Odds ratio, 7.869; 95% CI, 2.958-20.93; P<0.001), blood loss/body weight ratio >30ml/kg (Odds ratio, 4.350; 95% CI, 2.024-9.352; P<0.001), patients in early study period (2002-2010) (Odds ratio, 4.981; 95% CI, 1.831-13.55; P=0.002), male gender (Odds ratio, 3.528; 95% CI, 1.475-8.439; P=0.005), and remnant liver volume/weight ratio (%) <0.8% (Odds ratio, 2.943; 95% CI, 1.306-6.629; P=0.009) were identified as independent factors for PHLF.
Conclusions : The incidence of POPF is strongly associated with major HPD-related PHLF, suggesting the need to establish higher remnant liver functional criteria than those for hepatectomy with extrahepatic biliary resection.
Methods : We retrospectively analyzed cases of pancreaticoduodenectomy combined with major hepatectomy between 2002 and 2020. Risk factors for grade B/C postoperative pancreatic fistula and grade B/C posthepatectomy liver failure were examined.
Results : Among 176 study patients, PHLF and POPF occurred in 86 (49%), and 128 cases (73%), respectively. The incidence of POPF was associated with the incidence of PHLF (P=0.001). Postoperative mortality occurred in 11 cases (6%), all of which were cases with both POPF and PHLF. Multivariable analysis identified Body Mass Index >22 (Odds ratio, 5.127; 95% CI, 2.085-12.61; P<0.001), main pancreatic duct diameter <5mm (Odds ratio, 6.051; 95% CI, 1.586-23.09; P=0.008), and time to specimen taken-out >9 hours (Odds ratio, 7.040; 95% CI, 1.454-34.07; P=0.014), as independent factors for POPF. POPF (Odds ratio, 7.869; 95% CI, 2.958-20.93; P<0.001), blood loss/body weight ratio >30ml/kg (Odds ratio, 4.350; 95% CI, 2.024-9.352; P<0.001), patients in early study period (2002-2010) (Odds ratio, 4.981; 95% CI, 1.831-13.55; P=0.002), male gender (Odds ratio, 3.528; 95% CI, 1.475-8.439; P=0.005), and remnant liver volume/weight ratio (%) <0.8% (Odds ratio, 2.943; 95% CI, 1.306-6.629; P=0.009) were identified as independent factors for PHLF.
Conclusions : The incidence of POPF is strongly associated with major HPD-related PHLF, suggesting the need to establish higher remnant liver functional criteria than those for hepatectomy with extrahepatic biliary resection.
SESSION
Poster Presentation 6
Zone G 3/21/2024 2:50 PM - 3:30 PM