Major Complications Independently Increase Long-Term Mortality After Pancreatoduodenectomy for Cancer

M. Sandini, K. J. Ruscic, C. R. Ferrone, M. Qadan, M. Eikermann, A. L. Warshaw, K. D. Lillemoe, Carlos Fernández del Castillo

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Background: Postoperative major morbidity has been associated with worse survival gastrointestinal tumors. This association remains controversial in pancreatic cancer (PC). We analyzed whether major complications after surgical resection affect long-term survival. Methods: Records of all PC patients resected from 2007 to 2015 were reviewed. Major morbidity was defined as any grade-3 or higher 30-day complications, per the Clavien-Dindo Classification. Patients who died within 90 days after surgery were excluded from survival analysis. Results: Of 616 patients, 81.7% underwent pancreatoduodenectomy (PD) and 18.3% distal pancreatectomy (DP). Major complications occurred in 19.1% after PD and 15.9% after DP. In patients who survived > 90 days, the likelihood of receiving adjuvant treatment was 43.9% if major complications had occurred, vs. 68.5% if not (p < 0.001), and those who received it started the treatment median 10 days later compared with uncomplicated patients (median 60 days (50–72) vs. 50 days (41–61), p = 0.001). By univariate analysis, in addition to the conventional pathology-related prognostic determinants and the receipt of adjuvant treatment, major complications worsened long-term survival after PD (median OS 26 months vs. 15, p = 0.008). A difference was also seen after DP, but it did not reach statistical significance, likely related to the small sample size (median OS 33 months vs. 18, p = 0.189). At multivariate analysis for PD, major postoperative complications remained independently associated with worse survival [HR 1.37, 95%CI (1.01–1.86)]. Conclusions: Major surgical complications after pancreaticoduodenectomy are associated with worse long-term survival in pancreatic cancer. This effect is independent of the receipt of adjuvant treatment.

Original languageEnglish (US)
Pages (from-to)1984-1990
Number of pages7
JournalJournal of Gastrointestinal Surgery
Issue number10
StatePublished - Oct 1 2019
Externally publishedYes


  • Adjuvant treatment
  • Complications
  • Major morbidity
  • Pancreatic cancer
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology


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