Postoperative complications after pancreatoduodenectomy for malignancy: results from the Recurrence After Whipple’s (RAW) study
Authors: Russell Thomas B , Labib Peter L , Denson Jemimah , Streeter Adam , Ausania Fabio , Pando Elizabeth , Roberts Keith J , Kausar Ambareen , Mavroeidis Vasileios K , Marangoni Gabriele , Thomasset Sarah C , Frampton Adam E , Lykoudis Pavlos , Maglione Manuel , Alhaboob Nassir , Bari Hassaan , Smith Andrew M , Spalding Duncan , Srinivasan Parthi , Davidson Brian R , Bhogal Ricky H , Croagh Daniel , Dominguez Ismael , Thakkar Rohan , Gomez Dhanny , Silva Michael A , Lapolla Pierfrancesco , Mingoli Andrea , Porcu Alberto , Shah Nehal S , Hamady Zaed Z R , Al-Sarrieh Bilal A , Serrablo Alejandro ,   RAW Study Collaborators, Aroori Somaiah , Labib Peter L , Russell Thomas B , Streeter Adam , Denson Jemimah , Sheridan David , Puckett Mark , Browning Matthew G , Ausania Fabio , Gonzalez-Abos Carolina , Pando Elizabeth , Fernandes Nair , Moller Elsa Garcia , Taboada Cristina Dopazo , Roberts Keith J , Pande Rupaly , Alfarah Jameel , Kausar Ambareen , Bandyopadhyay Samik , Abdelrahim Ahmed , Khan Ayesha , Mavroeidis Vasileios K , Jordan Caitlin , Rees Jonathan R E , Marangoni Gabriele , Blege Harry , Thomasset Sarah C , Cambridge William , White Olga , Frampton Adam E , Blacker Sarah , Blackburn Jessie , Sweeney Casie , Lykoudis Pavlos , Field Daniel , Gouda Mohammed , Maglione Manuel , Bellotti Ruben , Alhaboob Nassir , Hamid Hytham K S , Bari Hassaan , Ahmed Hassan , Smith Andrew M , Moriarty Catherine , White Louise , Priestley Mark , Bode Kerry , Sharp Judith , Wragg Rosie , Jackson Beverley , Craven Samuel , Spalding Duncan , Fehervari Matyas , Pai Madhava , Alghazawi Laith , Onifade Anjola , Srinivasan Parthi , Ribaud Julliette , Nair Ashitha , Mariathasan Michael , Grayson Niamh , Davidson Brian R , Pericleous Stephanos , Patel Krishna , Shaw Conrad , Morare Nolitha , Zaban Mohamad Khish , Bhogal Ricky H , Doyle Joseph , Mavroeidis Vasileios K , Croagh Daniel , Dominguez Ismael , Guerrero Alan , Moguel Andre , Chan Carlos , Thakkar Rohan , Jones Michael , Buckley Edward , Akter Nasreen , Treherne Kyle , Gomez Dhanny , Gordon Gregory , Silva Michael A , Hughes Daniel , Urbonas Tomas , Lapolla Pierfrancesco , Mingoli Andrea , Brachini Gioia , Caronna Roberto , Chirletti Piero , Porcu Alberto , Perra Teresa , Shah Nehal S , Kahar Nurul Nadhirah Abd , Hall Thomas , Nadeem Nabeegh , Hamady Zaed Z R , Karar Shoura , Arshad Ali , Al-Sarrieh Bilal , Yarwood Adam , Hammoda Mohammed , Serrablo Alejandro , Artigas Maria , Paterna-López Sandra , Aroori Somaiah 
Published: December 2023

Abstract

Background
Pancreatoduodenectomy (PD) is associated with significant postoperative morbidity. Surgeons should have a sound understanding of the potential complications for consenting and benchmarking purposes. Furthermore, preoperative identification of high-risk patients can guide patient selection and potentially allow for targeted prehabilitation and/or individualized treatment regimens. Using a large multicentre cohort, this study aimed to calculate the incidence of all PD complications and identify risk factors.

Method
Data were extracted from the Recurrence After Whipple’s (RAW) study, a retrospective cohort study of PD outcomes (29 centres from 8 countries, 2012–2015). The incidence and severity of all complications was recorded and potential risk factors for morbidity, major morbidity (Clavien–Dindo grade &gt; IIIa), postoperative pancreatic fistula (POPF), post-pancreatectomy haemorrhage (PPH) and 90-day mortality were investigated.

Results
Among the 1348 included patients, overall morbidity, major morbidity, POPF, PPH and perioperative death affected 53 per cent (n = 720), 17 per cent (n = 228), 8 per cent (n = 108), 6 per cent (n = 84) and 4 per cent (n = 53), respectively. Following multivariable tests, a high BMI (P = 0.007), an ASA grade &gt; II (P &lt; 0.0001) and a classic Whipple approach (P = 0.005) were all associated with increased overall morbidity. In addition, ASA grade &gt; II patients were at increased risk of major morbidity (P &lt; 0.0001), and a raised BMI correlated with a greater risk of POPF (P = 0.001).

Conclusion
In this multicentre study of PD outcomes, an ASA grade &gt; II was a risk factor for major morbidity and a high BMI was a risk factor for POPF. Patients who are preoperatively identified to be high risk may benefit from targeted prehabilitation or individualized treatment regimens.