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Background: Pancreatoduodenectomy (PD) has long been associated with high rates of morbidity and mortality. Identification of early predictors of postoperative complications is important to minimize the morbidity of PD.
Objective: To assess the usefulness of systemic inflammatory response syndrome (SIRS) as a predictor of major complications after PD.
Hypotheses: 1) Early SIRS (postoperative day [POD] ≤3) can predict major complications after PD. 2) Late SIRS (POD 4-7) can predict late major complications (≥ POD 8) after PD.
Methods: A retrospective cohort study of 527 consecutive patients who underwent PD between 2007 and 2010 was performed. Incidence of SIRS was investigated three times a day (at the nearest point of 8, 16 and 24 o’clock) from POD 1 to POD 7. SIRS was diagnosed based on the standard criteria including body temperature, heart rate, respiratory rate and white blood cell count. A day of SIRS was defined by meeting the criteria of SIRS at two or more points during the same day. Postoperative incidence of SIRS was classified into two groups: Early SIRS (at least one day of SIRS between POD 1 and 3), and Late SIRS (at least one SIRS positive day between POD 4 and 7). The relationship between clinicopathological factors, Early and Late SIRS, and major complications was evaluated by univariate and multivariate analyses.
Results: Early and Late SIRS presented in 193 (37%) and 121 (23%) patients, respectively. Major complications were observed in 149 patients (28%) with72 (13%) patients developing late. Sixty-day mortality was 1.3%. Total number of days with SIRS was associated with severity of complication (P < 0.001). Incidence of Early SIRS was associated with postoperative major complication (P < 0.001) with a sensitivity and specificity of 57% and 71%, respectively. Multivariate analysis demonstrated that the incidence of Early SIRS (HR 2.5, 95% CI, 1.6 - 3.9, P < 0.001), soft pancreatic texture (HR 2.4, 95% CI 1.4 - 3.8, P < 0.001), and prolonged operative time (>360 min) (HR1.6, 95% CI 1.1 - 2.5, P = 0.02) were independent risk factors for major complications after PD. For late complications, multivariate analysis demonstrated that Late SIRS (HR 3.6, 95% CI 1.8 - 7.1, P < 0.001), soft pancreatic texture (HR 2.1, 95% CI 1.1 - 4.1, P = 0.01), and male patients (HR, 1.9, 95% CI 1.1 - 3.6, P = 0.02) were identified as independent risk factors.
Conclusion: In a large cohort of pancreaticoduodenectomy patients, early postoperative SIRS (POD≤3) was an independent predictor of major complications after PD; and, similarly, Late SIRS (POD 4-7) independently predicted late major complications (≥ POD 8).