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. 2022 Nov;46(11):2769-2777.
doi: 10.1007/s00268-022-06678-8. Epub 2022 Aug 8.

Preoperative Risk Score for Early Mortality After Up-Front Pancreatic Cancer Surgery: A Nationwide Cohort Study

Paulina Bereza-Carlson  1   2 , Johan Nilsson  3   4 , Bodil Andersson  5   6
Affiliations

Preoperative Risk Score for Early Mortality After Up-Front Pancreatic Cancer Surgery: A Nationwide Cohort Study

Paulina Bereza-Carlson et al. World J Surg. 2022 Nov.

Abstract

Background: Pancreatic ductal adenocarcinoma is a highly fatal malignancy. The aim was to identify preoperative factors for early mortality in up-front resectable patients following pancreatoduodenectomy (PD) and develop an early mortality risk score.

Methods: Patients registered in the Swedish National Registry for Pancreatic and Periampullary Cancer were included. Relevant preoperative factors (n = 21) were investigated. Early mortality was defined as death within 12 months after surgery. Based on the identified risk factor odds ratios (ORs), the Score Predicting Early Mortality (SPEM) was developed.

Results: In total, 2183 PDs were performed, and 926 patients met the study criteria. The mean age was 68 (SD ± 8.8) years, and 48% were female. A total of 233 (24%) patients died within 12 months. In the multivariable analyses, age > 75 years (OR 1.7; 95% CI 1.1-2.4; p = 0.008), CRP ≥ 15 mg/L (OR 2.0; 95% CI 1.3-3.1; p = 0.001), CA 19-9 > 500 U/mL (OR 1.8; 95% CI 1.0-3.2; p = 0.040), diabetes mellitus (OR 1.40; 95% CI 1.00-2.1; p = 0.042), and active smoking (OR 1.47; 95%CI 1.00-2.00; p = 0.050) were found to be independent risk factors for early mortality.

Conclusion: Five independent preoperative risk factors for early mortality following PD were identified and together formed SPEM. The score might be a useful tool in establishing individualized treatment plans.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Risk factors for death within 1 year after PD (correlation between survival and time after PD): a diabetes, b active smoking, c age, d CRP, e CA19-9
Fig. 2
Fig. 2
Overall survival, by preoperative predictive score SPEM, Log Rank test
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