Double bypass for inoperable pancreatic malignancy at laparotomy: postoperative complications and long-term outcome

• Published in: Annals of the Royal College of Surgeons of England Vol. 94; no. 8; pp. 563 - 568
• Main Authors: Ausania, F, Vallance, A E, Manas, D M, Prentis, J M, Snowden, C P, White, S A, Charnley, R M, French, J J, Jaques, B C
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-11-2012; Royal College of Surgeons
• Subjects: Adult; Anaerobic threshold; Anastomosis, Roux-en-Y - methods; Antigens; Chemotherapy; Endoscopy; Family medical history; Female; Gastroenterostomy - methods; Gastrointestinal Surgery; Heart surgery; Hospitals; Humans; Laparoscopy; Length of Stay; Male; Medical prognosis; Metabolism; Metastasis; Middle Aged; Morbidity; Mortality; Palliative Care - methods; Pancreatic cancer; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy - methods; Postoperative Complications - etiology; Postoperative period; Preoperative Care - methods; Prospective Studies; Risk Assessment; Stents; Survival Analysis; Systemic diseases; Treatment Outcome; Veins & arteries; Young Adult
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/003588412X13373405386934

Between 4% and 13% of patients with operable pancreatic malignancy are found unresectable at the time of surgery. Double bypass is a good option for fit patients but it is associated with a high risk of postoperative complications. The aim of this study was to identify pre-operatively which patients undergoing double bypass are at high risk of complications and to assess their long-term outcome.
Of the 576 patients undergoing pancreatic resections between 2006 and 2011, 50 patients who underwent a laparotomy for a planned pancreaticoduodenectomy had a double bypass procedure for inoperable disease. Demographic data, risk factors for postoperative complications and pre-operative anaesthetic assessment data including the Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) and cardiopulmonary exercise testing (CPET) were collected.
Fifty patients (33 men and 17 women) were included in the study. The median patient age was 64 years (range: 39-79 years). The complication rate was 50% and the in-hospital mortality rate was 4%. The P-POSSUM physiology subscore and low anaerobic threshold at CPET were significantly associated with postoperative complications (p =0.005 and p =0.016 respectively) but they were unable to predict them. Overall long-term survival was significantly shorter in patients with postoperative complications (9 vs 18 months). Postoperative complications were independently associated with poorer long-term survival (p =0.003, odds ratio: 3.261).
P-POSSUM and CPET are associated with postoperative complications but the possibility of using them for risk prediction requires further research. However, postoperative complications following double bypass have a significant impact on long-term survival and this type of surgery should therefore only be performed in specialised centres.