Concomitant Vascular Reconstruction During Pancreatectomy for Malignant Disease A Propensity Score–Adjusted, Population-Based Trend Analysis Involving 10 206 Patients Vascular Reconstruction and Pancreatic Surgery

Worni M, Castleberry AW, Clary BM, et al. — Mon, 01 Apr 2013 00:00:00 GMT

Objective

To assess trends in the frequency of concomitant vascular reconstructions (VRs) from 2000 through 2009 among patients who underwent pancreatectomy, as well as to compare the short-term outcomes between patients who underwent pancreatic resection with and without VR.

Design

Single-center series have been conducted to evaluate the short-term and long-term outcomes of VR during pancreatic resection. However, its effectiveness from a population-based perspective is still unknown. Unadjusted, multivariable, and propensity score–adjusted generalized linear models were performed.

Setting

Nationwide Inpatient Sample from 2000 through 2009.

Patients

A total of 10 206 patients were involved.

Main Outcome Measures

Incidence of VR during pancreatic resection, perioperative in-hospital complications, and length of hospital stay.

Results

Overall, 10 206 patients were included in this analysis. Of these, 412 patients (4.0%) underwent VR, with the rate increasing from 0.7% in 2000 to 6.0% in 2009 (P < .001). Patients who underwent pancreatic resection with VR were at a higher risk for intraoperative (propensity score–adjusted odds ratio, 1.94; P = .001) and postoperative (propensity score–adjusted odds ratio, 1.36; P = .008) complications, while the mortality and median length of hospital stay were similar to those of patients without VR. Among the 25% of hospitals with the highest surgical volume, patients who underwent pancreatic surgery with VR had significantly higher rates of postoperative complications and mortality than patients without VR.

Conclusions

The frequency of VR during pancreatic surgery is increasing in the United States. In contrast with most single-center analyses, this population-based study demonstrated that patients who underwent VR during pancreatic surgery had higher rates of adverse postoperative outcomes than their counterparts who underwent pancreatic resection only. Prospective studies incorporating long-term outcomes are warranted to further define which patients benefit from VR.

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Ellison E. — Mon, 01 Apr 2013 00:00:00 GMT

This first population-based study by Worni and colleagues allows broad insight into the immediate outcomes of vascular reconstruction (VR) in pancreatic cancer as practiced in the United States. It included 412 patients with VR—far more than in other studies. The key findings are that the frequency of VR increased from less than 1% in 2001 to greater than 6% in 2009; VR was associated with higher risks for intraoperative and postoperative complications and no increase in length of stay or mortality; and the 25% of highest-volume centers had higher rates of postoperative complications and mortality for patients who underwent pancreatic surgery with VR vs without VR. The study did not address survival. In my opinion, the conclusions are scientifically sound and valid, and they should give us pause to reconsider the role of VR in pancreatic cancer.

JAMA Surgery: Vascular Surgery Topic Collection

Concomitant Vascular Reconstruction During Pancreatectomy for Malignant Disease A Propensity Score–Adjusted, Population-Based Trend Analysis Involving 10 206 Patients Vascular Reconstruction and Pancreatic Surgery

Show Us the Money Comment on “Concomitant Vascular Reconstruction During Pancreatectomy for Malignant Disease”