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. 2022 Nov 11;22(1):389.
doi: 10.1186/s12893-022-01833-3.

Outcomes and risks in palliative pancreatic surgery: an analysis of the German StuDoQ|Pancreas registry

Felix O Hofmann  1 , Rainer C Miksch  1 , Maximilian Weniger  1 , Tobias Keck  2 , Matthias Anthuber  3 , Helmut Witzigmann  4 , Natascha C Nuessler  5 , Christoph Reissfelder  6   7 , Jörg Köninger  8 , Michael Ghadimi  9 , Detlef K Bartsch  10 , Werner Hartwig  11 , Martin K Angele  1 , Jan G D'Haese #  1 , Jens Werner #  12
Affiliations

Outcomes and risks in palliative pancreatic surgery: an analysis of the German StuDoQ|Pancreas registry

Felix O Hofmann et al. BMC Surg. .

Abstract

Background: Non-resectability is common in patients with pancreatic ductal adenocarcinoma (PDAC) due to local invasion or distant metastases. Then, biliary or gastroenteric bypasses or both are often established despite associated morbidity and mortality. The current study explores outcomes after palliative bypass surgery in patients with non-resectable PDAC.

Methods: From the prospectively maintained German StuDoQ|Pancreas registry, all patients with histopathologically confirmed PDAC who underwent non-resective pancreatic surgery between 2013 and 2018 were retrospectively identified, and the influence of the surgical procedure on morbidity and mortality was analyzed.

Results: Of 389 included patients, 127 (32.6%) underwent explorative surgery only, and a biliary, gastroenteric or double bypass was established in 92 (23.7%), 65 (16.7%) and 105 (27.0%). After exploration only, patients had a significantly shorter stay in the intensive care unit (mean 0.5 days [SD 1.7] vs. 1.9 [3.6], 2.0 [2.8] or 2.1 [2.8]; P < 0.0001) and in the hospital (median 7 days [IQR 4-11] vs. 12 [10-18], 12 [8-19] or 12 [9-17]; P < 0.0001), and complications occurred less frequently (22/127 [17.3%] vs. 37/92 [40.2%], 29/65 [44.6%] or 48/105 [45.7%]; P < 0.0001). In multivariable logistic regression, biliary stents were associated with less major (Clavien-Dindo grade ≥ IIIa) complications (OR 0.49 [95% CI 0.25-0.96], P = 0.037), whereas-compared to exploration only-biliary, gastroenteric, and double bypass were associated with more major complications (OR 3.58 [1.48-8.64], P = 0.005; 3.50 [1.39-8.81], P = 0.008; 4.96 [2.15-11.43], P < 0.001).

Conclusions: In patients with non-resectable PDAC, biliary, gastroenteric or double bypass surgery is associated with relevant morbidity and mortality. Although surgical palliation is indicated if interventional alternatives are inapplicable, or life expectancy is high, less invasive options should be considered.

Keywords: Biliary bypass; Explorative surgery; Gastroenteric bypass; Palliative surgery; Pancreatic ductal adenocarcinoma; Registry analysis.

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Conflict of interest statement

FOH has received a research leave grant from the Bavarian Centre for Cancer Research (BZKF), partner site Munich, Germany. MW has received funding from the German Research Foundation (DFG, Grant #401299842). The remaining authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study profile
Fig. 2
Fig. 2
Rate of complications. Rate and grade of complications according to Clavien–Dindo in general (a) and regarding different types of non-resective surgery (b)
Fig. 3
Fig. 3
Risk of major complication. Predictors of major complications (Clavien–Dindo grade ≥ IIIa). Results were derived from univariable, and multivariable logistic regression based of the imputed dataset including all 389 patients. The reference category is marked by an asterisk (*). ASA ASA physical status classification system, BMI body mass index, CA19-9 tumor marker carbohydrate antigen 19-9, CEA tumor marker carcinoembryonic antigen, CI confidence interval, IQR interquartile range, OR odds ratio
Fig. 4
Fig. 4
Recommended treatment algorithm. Recommended treatment algorithm of patients with pancreatic ductal adenocarcinoma. Rhombuses symbolize decisions, radiused rectangles symbolize interventions. Elements within the red box represent decisions or interventions during surgery. Grey boxes highlight different areas of concern such as obtaining histopathology, gastroduodenal obstruction, and biliary obstruction
See this image and copyright information in PMC

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