Hepatopancreatoduodenectomy in North America: are the outcomes acceptable?

Jonathan C Welch; Elizabeth M Gleeson; Andreas Karachristos; Henry A Pitt

doi:10.1016/j.hpb.2019.08.010

Hepatopancreatoduodenectomy in North America: are the outcomes acceptable?

HPB (Oxford). 2020 Mar;22(3):360-367. doi: 10.1016/j.hpb.2019.08.010. Epub 2019 Sep 10.

Authors

Jonathan C Welch¹, Elizabeth M Gleeson², Andreas Karachristos³, Henry A Pitt⁴

Affiliations

¹ Lewis Katz School of Medicine at Temple University, 3500 N. Broad St., Philadelphia, PA, 19140, USA.
² Department of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA.
³ Department of Surgery, University of South Florida, 2 Tampa General Circle 7th Floor, Tampa, FL, 33606, USA.
⁴ Lewis Katz School of Medicine at Temple University, 3509 N. Broad St., Boyer Pavilion, E938, Philadelphia, PA 1914, USA. Electronic address: Henry.Pitt@tuhs.temple.edu.

PMID: 31519357
DOI: 10.1016/j.hpb.2019.08.010

Abstract

Background: Hepatopancreatoduodenectomies (HPD) are historically associated with high morbidity and mortality. Currently, no data with hepatopancreatobiliary-specific complications have been available for HPD in North America. The aim of this retrospective analysis was to compare the outcomes of HPD to those of major hepatectomy (MH) and pancreatoduodenectomy (PD) in North America.

Methods: The 2014-16 American College of Surgeons-National Surgical Quality Improvement Program database was queried for MH, PD, and HPD. Partial hepatectomies, wedge liver biopsies, distal pancreatectomies, pancreatic enucleations and total pancreatectomies were excluded. Propensity score matching was utilized to match 23 HPDs to 92 MHs and 138 PDs by 28 demographic, comorbidity, laboratory, operative and pathologic variables. Outcomes were compared among these three groups.

Results: The overall morbidity and mortality for HPD were 87% and 26%, respectively, and were significantly higher (p < 0.01) compared to both MH (51%, 7.6%) and PD (52%, 1.4%). Post-hepatectomy liver failure (PHLF) was more common (p < 0.01) in HPD patients, but pancreatic fistula rates were similar.

Conclusion: The morbidity and mortality after HPD are significantly higher than after MH or PD alone and may explain why HPD is performed so infrequently in North America. Centralization of HPD to a very few centers may be a strategy to improve outcomes.

MeSH terms

Hepatectomy*
Humans
North America
Pancreaticoduodenectomy*
Patient Selection
Postoperative Complications / epidemiology*
Treatment Outcome