Outcomes following pancreatic resections—results and challenges of an Austrian university hospital compared to nationwide data and international centres

Abstract

SummaryBackgroundDespite clear advances in decreasing postoperative mortality below 4% after pancreatic resections in experienced centres, specific morbidity according to standardized definitions still remains high. While some recent multicentre studies have reported on complications after pancreatic surgery in Austria, detailed outcome data from single high-volume centres over longer time-periods are scarce. This study provides an in-depth picture of patient characteristics, indications, morbidity and mortality after pancreatic surgery in an Austrian tertiary referral centre.MethodsAll patients undergoing curative intent resection between 2010 and 2017 at the Medical University of Innsbruck were evaluated. Patient characteristics and procedural details, overall and specific complications including postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE) and post-pancreatectomy haemorrhage (PPH) rates according to accepted definitions are reported. Outcomes after pancreatic head resections, distal pancreatectomy and other types of resections are compared. Factors associated with severe and overall morbidity are evaluated by logistic regression modelling.ResultsA\xa0total of 343 patients underwent pancreatic resection, at a\xa0median of 64\xa0years (53% males). Most common indications were pancreatic or bile-duct carcinoma (52%), benign/precursor lesions (22%) and neuroendocrine tumours (11%). The 90-day mortality was 2%; 90-day overall/severe morbidity was 66.2%/22.4%. POPF grade\xa0B/C occurred in 19.3%, PPH in 17.5% and DGE in 14.3%. Male gender was associated with severe morbidity, body mass index and procedures other than distal resections with overall morbidity. POPF and PPH were major causes for relaparotomy.ConclusionsPancreatic resections in our centre are performed with low mortality, although morbidity still represents a\xa0relevant clinical problem, especially POPF and PPH.