Clinical and Functional Characteristics of Patients Undergoing Multivisceral Surgery With Pancreaticoduodenectomy

Abstract

BACKGROUND: Multivisceral procedures involving pancreaticoduodenectomy are associated with postoperative complications that worsen the general condition of patients, hinder specialized treatment initiation, and increase treatment-related risks.

AIM: To investigate the clinical and functional characteristics of patients undergoing multivisceral surgery with pancreaticoduodenectomy.

MATERIAL AND METHODS: The study included 251 patients who underwent multivisceral resection with pancreaticoduodenectomy (group 1) for tumors of various localizations between January 2011 and April 2024 at two institutions: National Medical Research Center of Oncology, named after N.N. Blokhin, and Republican Clinical Oncological Dispansery, named after Prof. M.Z. Sigal. The control group comprised 832 patients who underwent standard-volume pancreaticoduodenectomy (group 2) at the same institutions during the same period. The patients’ sex, age, ECOG performance status, ASA physical status classification, body mass index, comorbidities, tumor-related complications, and characteristics of the pancreatic remnant, which are major determinants of postoperative complications, were evaluated. Continuous variables are described using the median and lower and upper quartiles (Q1–Q3). Categorical variables are presented as absolute numbers and percentages. The continuous variables of the two groups were compared using the Mann–Whitney U test. Comparison of percentage distributions in 2×2 contingency tables was performed using Pearson’s χ² test. Differences were considered significant at p <0.05.

RESULTS: Group 1 had a significantly higher proportion of patients with ECOG scores of 2 (30.3 vs. 8.7%, p <0.001) and 3 (4.4 vs. 0.7%, p <0.001), a lower prevalence of obesity (8.8 vs. 15.7%), and fewer elderly patients (38.6 vs. 54.6%). Anemia (38.2 vs. 10.2%, p <0.001), tumor-related stenosis (19.5 vs. 2.5%, p <0.001), and enteric fistula or peritumoral abscess (10.4 vs. 0.6%, p <0.001) were significantly more common in group 1, whereas obstructive jaundice was more frequent in group 2 (47.8 vs. 69.5%, p <0.001). The pancreatic duct diameter was significantly smaller in group 1 (0.3 mm [0.2–0.4] vs. 0.4 mm [0.2–0.5], p <0.001), whereas pancreatic parenchymal density did not significantly differ between the groups.

CONCLUSION: Patients undergoing multivisceral surgery that includes pancreaticoduodenectomy represent a clinically more complex cohort with poorer overall functional status compared with those undergoing standard pancreaticoduodenectomy without adjacent organ resection.

Keywords

multivisceral surgery / pancreaticoduodenectomy / pancreatic cancer / anesthetic risk

RIGHTS & PERMISSIONS

Eco-Vector