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Emergent pancreatectomy for neoplastic disease: outcomes analysis of 534 ACS-NSQIP patients

Background While emergent pancreatic resection for trauma has been previously described, no large contemporary investigations into the frequency, indications, and outcomes of emergent pancreatectomy (EP) secondary to complications of neoplastic disease exist. Modern perioperative outcomes data are c...

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Published in:BMC surgery 2020-07, Vol.20 (1), p.1-169, Article 169
Main Authors: Driedger, Michael R, Puig, Carlos A, Thiels, Cornelius A, Bergquist, John R, Ubl, Daniel S, Habermann, Elizabeth B, Grotz, Travis E, Smoot, Rory L, Nagorney, David M, Cleary, Sean P, Kendrick, Michael L, Truty, Mark J
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container_end_page 169
container_issue 1
container_start_page 1
container_title BMC surgery
container_volume 20
creator Driedger, Michael R
Puig, Carlos A
Thiels, Cornelius A
Bergquist, John R
Ubl, Daniel S
Habermann, Elizabeth B
Grotz, Travis E
Smoot, Rory L
Nagorney, David M
Cleary, Sean P
Kendrick, Michael L
Truty, Mark J
description Background While emergent pancreatic resection for trauma has been previously described, no large contemporary investigations into the frequency, indications, and outcomes of emergent pancreatectomy (EP) secondary to complications of neoplastic disease exist. Modern perioperative outcomes data are currently 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-ampullary neoplasms from 2005 to 2013. Patients treated for complications of pancreatitis were specifically excluded. Emergent operation was defined as NSQIP criteria for emergent case and one of the following: ASA Class 5, preoperative ventilator dependency, preoperative SIRS, sepsis, or septic shock, or requirement of > 4 units RBCs in 72 h prior to resection. Chi-square tests, Fisher's exact tests were performed to compare postoperative outcomes between emergent and elective cases as well as between pancreatectomy types. Results Of 21,452 patients who underwent pancreatectomy for neoplastic indications, we identified 534 (2.5%) patients who underwent emergent resection. Preoperative systemic sepsis (66.3%) and bleeding (17.9%) were most common indications for emergent operation. PD was performed in 409 (77%) patients, DP in 115 (21%), and TP in 10 (2%) patients. Overall major morbidity was significantly higher (46.1% vs. 25.6%, p < 0.001) for emergent vs. elective operations. Emergent operations resulted in increased transfusion rates (47.6% vs. 23.4%, p < 0.001), return to OR (14.0% vs. 5.6%, p < 0.001), organ-space infection (14.6 vs. 10.5, p = 0.002), unplanned intubation (9.% vs. 4.1%, p < 0.001), pneumonia (9.6% vs. 4.2%, p < 0.001), length of stay (14 days vs. 8 days, p < 0.001), and discharge to skilled facility (31.1% vs. 13.9%). These differences persisted when stratified by pancreatic resection type. The 30-day operative mortality was higher in the emergent group (9.4%vs. 2.7%, p < 0.001) and highest for emergent TP (20%). Conclusion Emergent pancreatic resection is markedly uncommon in the setting of neoplastic disease. Although these operations result in increased morbidity and mortality compared to elective resections, they can be life-saving in specific circumstances. The results of this large series of modern era national data may assist surgeons as well as patients and their families in making critical decisions in se
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Modern perioperative outcomes data are currently 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-ampullary neoplasms from 2005 to 2013. Patients treated for complications of pancreatitis were specifically excluded. Emergent operation was defined as NSQIP criteria for emergent case and one of the following: ASA Class 5, preoperative ventilator dependency, preoperative SIRS, sepsis, or septic shock, or requirement of > 4 units RBCs in 72 h prior to resection. Chi-square tests, Fisher's exact tests were performed to compare postoperative outcomes between emergent and elective cases as well as between pancreatectomy types. Results Of 21,452 patients who underwent pancreatectomy for neoplastic indications, we identified 534 (2.5%) patients who underwent emergent resection. Preoperative systemic sepsis (66.3%) and bleeding (17.9%) were most common indications for emergent operation. PD was performed in 409 (77%) patients, DP in 115 (21%), and TP in 10 (2%) patients. Overall major morbidity was significantly higher (46.1% vs. 25.6%, p < 0.001) for emergent vs. elective operations. Emergent operations resulted in increased transfusion rates (47.6% vs. 23.4%, p < 0.001), return to OR (14.0% vs. 5.6%, p < 0.001), organ-space infection (14.6 vs. 10.5, p = 0.002), unplanned intubation (9.% vs. 4.1%, p < 0.001), pneumonia (9.6% vs. 4.2%, p < 0.001), length of stay (14 days vs. 8 days, p < 0.001), and discharge to skilled facility (31.1% vs. 13.9%). These differences persisted when stratified by pancreatic resection type. The 30-day operative mortality was higher in the emergent group (9.4%vs. 2.7%, p < 0.001) and highest for emergent TP (20%). Conclusion Emergent pancreatic resection is markedly uncommon in the setting of neoplastic disease. Although these operations result in increased morbidity and mortality compared to elective resections, they can be life-saving in specific circumstances. The results of this large series of modern era national data may assist surgeons as well as patients and their families in making critical decisions in select cases of acutely complicated neoplastic disease. Keywords: Emergent, Pancreatectomy, Pancreas resection, Neoplasm, Cancer, Oncology]]></description><identifier>ISSN: 1471-2482</identifier><identifier>EISSN: 1471-2482</identifier><identifier>DOI: 10.1186/s12893-020-00822-8</identifier><identifier>PMID: 32718311</identifier><language>eng</language><publisher>London: BioMed Central Ltd</publisher><subject>Abdomen ; Analysis ; Antineoplastic agents ; Bleeding ; Cancer ; Care and treatment ; Chemotherapy ; Complications ; Cysts ; Demographics ; Disease ; Emergent ; Fistula ; Infection ; Infections ; Intubation ; Morbidity ; Mortality ; Neoplasia ; Neoplasm ; Neoplasms ; Neuroendocrine tumors ; Oncology ; Pancreas ; Pancreas resection ; Pancreatectomy ; Pancreatic cancer ; Pancreaticoduodenectomy ; Pancreatitis ; Patient outcomes ; Patients ; Sepsis ; Septic shock ; Surgery ; Transfusion ; Trauma ; Ventilators</subject><ispartof>BMC surgery, 2020-07, Vol.20 (1), p.1-169, Article 169</ispartof><rights>COPYRIGHT 2020 BioMed Central Ltd.</rights><rights>2020. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). 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Modern perioperative outcomes data are currently 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-ampullary neoplasms from 2005 to 2013. Patients treated for complications of pancreatitis were specifically excluded. Emergent operation was defined as NSQIP criteria for emergent case and one of the following: ASA Class 5, preoperative ventilator dependency, preoperative SIRS, sepsis, or septic shock, or requirement of > 4 units RBCs in 72 h prior to resection. Chi-square tests, Fisher's exact tests were performed to compare postoperative outcomes between emergent and elective cases as well as between pancreatectomy types. Results Of 21,452 patients who underwent pancreatectomy for neoplastic indications, we identified 534 (2.5%) patients who underwent emergent resection. Preoperative systemic sepsis (66.3%) and bleeding (17.9%) were most common indications for emergent operation. PD was performed in 409 (77%) patients, DP in 115 (21%), and TP in 10 (2%) patients. Overall major morbidity was significantly higher (46.1% vs. 25.6%, p < 0.001) for emergent vs. elective operations. Emergent operations resulted in increased transfusion rates (47.6% vs. 23.4%, p < 0.001), return to OR (14.0% vs. 5.6%, p < 0.001), organ-space infection (14.6 vs. 10.5, p = 0.002), unplanned intubation (9.% vs. 4.1%, p < 0.001), pneumonia (9.6% vs. 4.2%, p < 0.001), length of stay (14 days vs. 8 days, p < 0.001), and discharge to skilled facility (31.1% vs. 13.9%). These differences persisted when stratified by pancreatic resection type. The 30-day operative mortality was higher in the emergent group (9.4%vs. 2.7%, p < 0.001) and highest for emergent TP (20%). Conclusion Emergent pancreatic resection is markedly uncommon in the setting of neoplastic disease. Although these operations result in increased morbidity and mortality compared to elective resections, they can be life-saving in specific circumstances. The results of this large series of modern era national data may assist surgeons as well as patients and their families in making critical decisions in select cases of acutely complicated neoplastic disease. Keywords: Emergent, Pancreatectomy, Pancreas resection, Neoplasm, Cancer, Oncology]]></description><subject>Abdomen</subject><subject>Analysis</subject><subject>Antineoplastic agents</subject><subject>Bleeding</subject><subject>Cancer</subject><subject>Care and treatment</subject><subject>Chemotherapy</subject><subject>Complications</subject><subject>Cysts</subject><subject>Demographics</subject><subject>Disease</subject><subject>Emergent</subject><subject>Fistula</subject><subject>Infection</subject><subject>Infections</subject><subject>Intubation</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Neoplasia</subject><subject>Neoplasm</subject><subject>Neoplasms</subject><subject>Neuroendocrine tumors</subject><subject>Oncology</subject><subject>Pancreas</subject><subject>Pancreas resection</subject><subject>Pancreatectomy</subject><subject>Pancreatic cancer</subject><subject>Pancreaticoduodenectomy</subject><subject>Pancreatitis</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Sepsis</subject><subject>Septic shock</subject><subject>Surgery</subject><subject>Transfusion</subject><subject>Trauma</subject><subject>Ventilators</subject><issn>1471-2482</issn><issn>1471-2482</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNptkk2LFDEQhhtR3HX1D3hq8OKl13wn7UEYhlUHFj9YPXkItenKmKG7Mybdwvx70zuL7IjkkFB566l6i6qql5RcUmrUm0yZaXlDGGkIMYw15lF1ToWmDROGPX7wPque5bwjhGoj5dPqjDNNDaf0vPpxNWDa4jjVexhdQpjQTXE41D6mesS47yFPwdVdyAgZ39ZxnlwcMNcwQn_IIdfR15KLerW-aT7dfN18KaQpFGJ-Xj3x0Gd8cX9fVN_fX31bf2yuP3_YrFfXjZOCTI3jztEWhOTec9J1VHGqDCdaOfDYUQR0kgEaqTTRHZG3WnWea9kyI40h_KLaHLldhJ3dpzBAOtgIwd4FYtpaSMVEj9ZLJkFqlEJQwYxphWbet6YlDpQnWFjvjqz9fDtg54qPBP0J9PRnDD_tNv62mpdmVFsAr-8BKf6aMU92CNlh30OZ5pwtK2WJkpItfb_6R7qLcypjXVRcEma4eqDaQjEQRh9LXbdA7apMqiWaiaXs5X9U5XQ4BBdH9KHETxLYMcGlmHNC_9cjJXZZL3tcL1vWy96tlzX8D7PtvlY</recordid><startdate>20200727</startdate><enddate>20200727</enddate><creator>Driedger, Michael R</creator><creator>Puig, Carlos A</creator><creator>Thiels, Cornelius A</creator><creator>Bergquist, John R</creator><creator>Ubl, Daniel S</creator><creator>Habermann, Elizabeth B</creator><creator>Grotz, Travis E</creator><creator>Smoot, Rory L</creator><creator>Nagorney, David M</creator><creator>Cleary, Sean P</creator><creator>Kendrick, Michael L</creator><creator>Truty, Mark J</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><general>BMC</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-8668-7071</orcidid></search><sort><creationdate>20200727</creationdate><title>Emergent pancreatectomy for neoplastic disease: outcomes analysis of 534 ACS-NSQIP patients</title><author>Driedger, Michael R ; 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Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Publicly Available Content (ProQuest)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>BMC surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Driedger, Michael R</au><au>Puig, Carlos A</au><au>Thiels, Cornelius A</au><au>Bergquist, John R</au><au>Ubl, Daniel S</au><au>Habermann, Elizabeth B</au><au>Grotz, Travis E</au><au>Smoot, Rory L</au><au>Nagorney, David M</au><au>Cleary, Sean P</au><au>Kendrick, Michael L</au><au>Truty, Mark J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Emergent pancreatectomy for neoplastic disease: outcomes analysis of 534 ACS-NSQIP patients</atitle><jtitle>BMC surgery</jtitle><date>2020-07-27</date><risdate>2020</risdate><volume>20</volume><issue>1</issue><spage>1</spage><epage>169</epage><pages>1-169</pages><artnum>169</artnum><issn>1471-2482</issn><eissn>1471-2482</eissn><abstract><![CDATA[Background While emergent pancreatic resection for trauma has been previously described, no large contemporary investigations into the frequency, indications, and outcomes of emergent pancreatectomy (EP) secondary to complications of neoplastic disease exist. Modern perioperative outcomes data are currently 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-ampullary neoplasms from 2005 to 2013. Patients treated for complications of pancreatitis were specifically excluded. Emergent operation was defined as NSQIP criteria for emergent case and one of the following: ASA Class 5, preoperative ventilator dependency, preoperative SIRS, sepsis, or septic shock, or requirement of > 4 units RBCs in 72 h prior to resection. Chi-square tests, Fisher's exact tests were performed to compare postoperative outcomes between emergent and elective cases as well as between pancreatectomy types. Results Of 21,452 patients who underwent pancreatectomy for neoplastic indications, we identified 534 (2.5%) patients who underwent emergent resection. Preoperative systemic sepsis (66.3%) and bleeding (17.9%) were most common indications for emergent operation. PD was performed in 409 (77%) patients, DP in 115 (21%), and TP in 10 (2%) patients. Overall major morbidity was significantly higher (46.1% vs. 25.6%, p < 0.001) for emergent vs. elective operations. Emergent operations resulted in increased transfusion rates (47.6% vs. 23.4%, p < 0.001), return to OR (14.0% vs. 5.6%, p < 0.001), organ-space infection (14.6 vs. 10.5, p = 0.002), unplanned intubation (9.% vs. 4.1%, p < 0.001), pneumonia (9.6% vs. 4.2%, p < 0.001), length of stay (14 days vs. 8 days, p < 0.001), and discharge to skilled facility (31.1% vs. 13.9%). These differences persisted when stratified by pancreatic resection type. The 30-day operative mortality was higher in the emergent group (9.4%vs. 2.7%, p < 0.001) and highest for emergent TP (20%). Conclusion Emergent pancreatic resection is markedly uncommon in the setting of neoplastic disease. Although these operations result in increased morbidity and mortality compared to elective resections, they can be life-saving in specific circumstances. The results of this large series of modern era national data may assist surgeons as well as patients and their families in making critical decisions in select cases of acutely complicated neoplastic disease. Keywords: Emergent, Pancreatectomy, Pancreas resection, Neoplasm, Cancer, Oncology]]></abstract><cop>London</cop><pub>BioMed Central Ltd</pub><pmid>32718311</pmid><doi>10.1186/s12893-020-00822-8</doi><orcidid>https://orcid.org/0000-0002-8668-7071</orcidid><oa>free_for_read</oa></addata></record>
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subjects Abdomen
Analysis
Antineoplastic agents
Bleeding
Cancer
Care and treatment
Chemotherapy
Complications
Cysts
Demographics
Disease
Emergent
Fistula
Infection
Infections
Intubation
Morbidity
Mortality
Neoplasia
Neoplasm
Neoplasms
Neuroendocrine tumors
Oncology
Pancreas
Pancreas resection
Pancreatectomy
Pancreatic cancer
Pancreaticoduodenectomy
Pancreatitis
Patient outcomes
Patients
Sepsis
Septic shock
Surgery
Transfusion
Trauma
Ventilators
title Emergent pancreatectomy for neoplastic disease: outcomes analysis of 534 ACS-NSQIP patients
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