Back to 2008 Program and Abstracts
Background: Previous studies have identified an association between dilated pancreatic and biliary ducts and lower rates of pancreatic leak after pancreaticoduodenectomy (PD), but it remains unclear whether elevated liver function tests (LFTs) are also associated with lower rates of complications. The purpose of this study was to determine the predictive ability of preoperative LFTs on morbidity following PD. Materials and
Methods: We identified 452 patients who received PD at Loyola University Medical Center from 1990-2007. Each patient received standard PD with one of two anastomotic variants: pancreaticogastrostomy (PG) or pancreaticojejeunostomy (PJ). A panel of preoperative serum lab values and postoperative complication data was collected for each patient, and regression analyses were performed to identify predictors of postoperative complications. Normal values were determined according to our institution’s laboratory guidelines.
Results: 452 patients were analyzed. Mean age at surgery was 65 years, and 56% of the patients were male. 64% of patients experienced no significant postoperative complications. Among those patients who experienced complications, pancreatic leak was most commonly observed, with an incidence of 16%. There were no significant differences between PG and PJ with respect to postoperative complications. Mortality within 30 days of PD was 2% for the study population and was not significantly different between PG and PJ groups. In a univariate analysis, patients with a low or normal preoperative AST had a higher incidence of complications when compared to those patients with an elevated AST (p=0.03). Additionally, a higher proportion of postoperative complications was demonstrated in those patients with a low or normal alkaline phosphatase when compared to patients with elevated preoperative levels (p=0.03). Interestingly, preoperative hypoalbuminemia was not significantly associated with increased rates of complications. Multivariate analysis confirmed that an elevated alkaline phosphatase was associated with a lower incidence of postoperative complications (OR=0.56, p=0.02). Preoperative anemia (hemoglobin <14.0) was found to be an independent predictor of postoperative complications following PD as well (OR=2.01, p=0.02).
Conclusions: Patients who were anemic and those with normal LFTs were significantly more likely to experience a complication after PD. This may represent extent of disease and tumors not causing biliary or pancreatic dilatation, respectively. Precautions, such as intraoperative ductal stents, should be considered when operating on this group of patients in order to minimize complications.
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