Aim: To investigate the influence of different diagnoses (chronic pancreatitis vs. pancreatic-head Ca) & interindividual differences like age & secondary diseases on the early postop. outcome in a comparable state of interventional invasiveness, surgical trauma & related SIRS.
Method: Over a defined period of time, all consecutive patients who had undergone PPPHR with "Pan.” & "Ca" in the above mentioned abdominal surgery department were recorded & examined with regard to different outcome parameters such as postop. morbidity (in particular, characterized by general/specific complication rate), 30-d mortality, microbial colonization as well as SIRS- & SOFA-associated parameters.
Results: From 2003-2015, in total 315 patients were enrolled, of whom n=290 (sex ratio, m/w=178:112 [1.59:1]; median age, 59 [range: 20-82] years [yrs]) were evaluated. Out of them, 194 cases with Ca (66.9%) & 96 individuals with Pan. (33.1%) were subclassified. Median age was significantly different: 68 (37-82) vs. 51 (20-62) yrs for Ca & Pan., respectively (p<0.001), with a trend for a different mean ASA score of 2.3 (Ca [1-4]) & 2.1 (Pan. [1-4]; p=0.084). The median preop. hospital stay was 2 [0-17] d for both diseases; postoperatively, patients were hospitalized for 18 (Ca [2-88]) & 15 (Pan. [6-48]) d with a significant difference (p=0.029).
Surprising were the similar general & specific complication rates of 21.6% (Ca) vs. 15.6% (Pan.) & 39.7% (Ca) vs. 42.7% (Pan.) (resp.; p=0.224; p=0.623), & the corresponding 30-d mortalities of 2.6% (Ca) vs. 2.1% (Pan.; p=0.796).
Of the potential factors influencing morbidity (general/specific/total) & mortality, gender, age, ASA scoring, secondary diagnoses, abuse habits (nicotine/alcohol), BMI, preop. CRP & white blood cell counts as well as the definitive diagnosis were tested using univariate analysis, with a significant impact of the ASA category & BMI onto the general complications (p=0.013 / p=0.041).
Multivariate analysis using logistic regression revealed that intraoperatively administered red cell packs showed a significant impact onto the general & specific complication rates (p=0.004 / p=0.0001) as well as mortality (p=0.001). Female patients had a significantly lower microbial colonization postoperatively (p=0.0004), whereas the diagnosis (Pan. vs. Ca) did not have any influence thereon (p=0.305). The postop. SOFA Score was higher in the Ca group, even though the complication rates were similar.
Conclusion: The influence of the cancer, which was previously considered to be disadvantageous (rather unfavorable soft pancreas, immunosuppressive phenomenon) in comparison to chronic inflammation, in spite of significant higher age & longer postop. hospitalization of the patients, cannot be clearly detected on the basis of the morbidity & mortality data mentioned above representing early postop. outcome.
