Impact of Prior Abdominal Surgery on Outcomes of Pancreaticoduodenectomy

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-9-2025

Abstract

Pancreatic cancer is the 14th most common cancer globally and a leading cause of cancer-related deaths. Pancreaticoduodenectomy (Whipple procedure) remains the only curative option, but it is a highly complex surgery, particularly in patients with prior abdominal surgery due to adhesions and altered anatomy. Specialty centers report relatively low mortality rates (1-6%), but morbidity can reach 50%. The impact of prior abdominal surgery on Whipple outcomes remains poorly understood, with conflicting evidence. Some studies report no significant differences in perioperative complications, while others suggest increased mortality and severe complications. Given these disparities, further research is essential to understand better how prior abdominal surgery influences morbidity and mortality in patients undergoing pancreaticoduodenectomy.

A retrospective cohort study was conducted at a single academic medical center, analyzing data from patients who underwent pancreaticoduodenectomy between November 2017 and October 2024. Patients were stratified using a modified Prior Surgical Score (PSS) system, termed the Surgical Impact Score (SIS), which categorizes previous surgical interventions by increasing impact: 0 (laparoscopic pelvic surgery/no prior surgery), 1 (laparoscopic upper abdominal surgery), 2 (open abdominal surgery), and 3 (open upper abdominal surgery). Data was collected on patient demographics, co-morbidities, pre-operative evaluation details, surgical details, postoperative outcomes, and postoperative complications on the Clavien-Dindo scale. Statistical analysis included descriptive statistics and group comparisons utilizing pair-wise t-tests.

A total of 276 patients were included (147 males, 129 females), with a mean age of 65.3 (SD 11.8) years and a mean BMI of 5.2 (SD 5.2). The Surgical Impact Score (SIS) was 0 for 111 patients (40%), 1 for 96 (35%), 2 for 33 (12%), and 3 for 34 (12%). No significant differences in SIS were observed for operative duration (p = 0.697), length of stay (p = 804), postoperative pancreatic fistula (p=0.704), delayed gastric emptying (p=0.905), surgical site infection (p=0.141), intra-abdominal abscess (p=0.676), wound dehiscence (p=0.390), total parenteral nutrition requirement (p=0.628), reoperation (p=0.265), or transfusions (p=0.433). There were no 30-day mortalities in our cohort. However, higher Surgical Impact Scores were associated with significantly higher 30-day readmission rates (SIS 3: 41% vs. 17-24% in other groups, p=0.05) and higher 90-day mortality (SIS 3: 12% vs. 0-1% in other groups, p<0.001).

Higher Surgical Impact Scores correlate with significantly increased 30-day readmissions and 90-day mortality, emphasizing the critical role of prior surgical history in preoperative planning. These findings highlight the importance of thorough risk assessment and patient counseling to improve outcomes in this high-risk population.

Comments

2025 Research Day Corewell Health West, Grand Rapids, MI, May 9, 2025. Abstract 1677

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