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NON-TRAUMATIC EMERGENT PANCREATECTOMY FOR NEOPLASTIC DISEASE: ANALYSIS OF 534 ACS-NSQIP PATIENTS
Carlos A. Puig*, Cornelius A. Thiels, John R. Bergquist, Daniel S. Ubl, Rory Smoot, David M. Nagorney, Michael B. Farnell, Michael L. Kendrick, Elizabeth B. Habermann, Mark J. Truty
Department of subspecialty general surgery, Mayo Clinic, Rochester, MN
Introduction
While emergent pancreatic resection for trauma has been previously well described, there have been no large contemporary series and investigations into the frequency, indications, and outcomes of emergent pancreatectomy secondary to complications of neoplastic disease. Prior historical reports have been small single-institution series suggesting poor outcomes. Database studies typically exclude these emergent cases from their analyses thus large series outcomes are unknown.
Methods
ACS-NSQIP was reviewed for all non-traumatic pancreatic resections (DP - distal pancreatectomy, PD - pancreaticoduodenectomy, or TP- total pancreatectomy) in patients with pancreatico-biliary or duodenal neoplastic disease from 2005-2013. Emergent operation was defined as NSQIP criteria for emergent case and/or one of the following: ASA Class 5, preoperative ventilator dependency, preoperative sepsis, or requirement of >4 units RBCs in 72 hours prior to resection. Chi-square tests, Fisher’s exact tests were performed to compare postoperative outcomes
Results
Of 21,452 patients who underwent pancreatectomy for neoplastic indications, we identified 534 (2.5%) patients that underwent emergent pancreatectomy. Preoperative systemic sepsis (66.3%) and bleeding (17.9%) were most common indications for emergent operation. Overall 30-day mortality (9.4% vs. 2.7%), major morbidity (46.1% vs. 25.6%), perioperative PRBC transfusion (47.6% vs. 23.4%), return to OR (14% vs. 5.6%), any SSI (26.6% vs. 19.6%), UTI (8.8% vs. 4.6%), unplanned intubation (9% vs. 4.1%), pneumonia (9.6% vs. 4.2%), length of stay (14 days vs. 11 days), and discharge to skilled facility (22% vs. 11.7%) were expectedly higher in the emergent cohort. For emergent cases, PD was performed more often (76.5% vs. 68.8%), DP was less common (21.5% vs. 29.0%), and TP was similar (1.9% vs. 2.1%) compared to elective cohorts. Similar worse outcomes persisted when stratified by type of pancreatic resection (DP, PD, TP), with the highest mortality found for emergent TP (20.0%).
Conclusion
Emergent pancreatic resection for neoplastic disease results in substantial mortality and morbidity. The results of this large series of modern national data may assist surgeons in making emergent operative decisions in select cases and provide more informed risk counseling on expected outcomes after such rare unanticipated procedures.
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