ABSTRACT
BACKGROUND: Recent studies have shown that a selective group of patients with primary cystic neoplasms of the pancreas can be managed conservatively by radiological follow-up. The aim of this study was to analyze if such a strategy is efficient and safe. PATIENTS AND METHODS: A retrospective analyses was performed of patients who underwent resection between January 1992 and January 2006 for primary cystic neoplasms of the pancreas in an era of aggressive management (i.e. all patients underwent resection) in order to analyze if the selective algorithm as proposed by the Memorial Sloan-Kettering Cancer Center is efficient and safe. RESULTS: One hundred patients underwent a resection for pancreatic cysts. Thirty-five percent of the patients with symptomatic cysts had a (pre)malignant lesion compared with 15% of the patients with an incidental cysts. In hospital mortality occurred in 1% of the patients and a postoperative complications in 39%. The Memorial Sloan-Kettering Cancer Center nomogram was able to correctly identify all patients with a benign incidental cyst. CONCLUSION: A selective management strategy can be implemented and algorithm proposed by the Memorial Sloan-Kettering Cancer Center nomogram is safe and efficient.
Subject(s)
Algorithms , Pancreatectomy , Pancreatic Cyst/surgery , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy , Adolescent , Adult , Aged , Aged, 80 and over , Decision Trees , Female , Follow-Up Studies , Humans , Incidental Findings , Male , Middle Aged , Pancreatic Cyst/diagnosis , Pancreatic Neoplasms/diagnosis , Postoperative Complications , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: Comparison of operative morbidity rates after pancreatoduodenectomy between units may be misleading because it does not take into account the physiological variable of the condition of the patients. The aim of the present study was to evaluate the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) for pancreatoduodenectomy patients and to look for risk factors associated with morbidity in a high-volume center. METHODS: Between January 1993 and April 2006, 652 patients underwent a pancreatoduodenectomy, 502 of them for malignant disease. POSSUM performance was evaluated by assessing the "goodness-of-fit" with the linear analysis method. RESULTS: Overall, 332 of the 652 patients (50.9%) had one or more complication after pancreatoduodenectomy, and 9 patients (1.4%) died. POSSUM had a significant lack of fit using goodness-of-fit analysis. In multivariate analysis, one statistically significant factor associated with morbidity and not incorporated in POSSUM (P < 0.05) was identified: ampulla of Vater adenocarcinoma (OR = 1.73, 95% CI: 1.07-2.80). CONCLUSIONS: Overall, there is a lack of calibration of POSSUM among patients who undergo pancreatoduodenectomy.
Subject(s)
Neoplasm Invasiveness/pathology , Pancreatic Neoplasms/mortality , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy/mortality , Postoperative Complications/mortality , Aged , Analysis of Variance , Cohort Studies , Confidence Intervals , Disease-Free Survival , Female , Humans , Linear Models , Male , Middle Aged , Multivariate Analysis , Neoplasm Staging , Netherlands , Odds Ratio , Pancreatic Neoplasms/pathology , Pancreaticoduodenectomy/methods , Postoperative Care/methods , Predictive Value of Tests , Preoperative Care/methods , Probability , Prognosis , Retrospective Studies , Risk Assessment , Severity of Illness Index , Survival AnalysisABSTRACT
BACKGROUND: The aim of this study was to evaluate the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) for patients with unresectable pancreatic cancer and to analyze whether POSSUM can predict the long-term outcome in these patients. Such a scoring system could be useful to aid in the decision between surgical and endoscopic palliation. METHODS: Between January 1993 and December 2004, 241 patients were found to have unresectable pancreatic cancer during exploratory laparotomy and underwent a double bypass procedure consisting of a gastrojejunostomy and a hepaticojejunostomy. RESULTS: Overall, 64 of 240 patients (27%) had one or more complications after bypass surgery and 4 patients (2%) died. POSSUM predicted morbidity in 114 patients (47%). The observed:predicted (O:P) ratio for morbidity was 0.56 and the model had a significant lack of fit (p < 0.001) using a goodness-of-fit analysis. The overall median survival was 7 months. The POSSUM scoring system was, however, an independent predictor of survival in multivariate analysis. CONCLUSIONS: Overall, POSSUM overpredicted morbidity but was an independent predictor of survival.
