Nationwide analysis of one-year mortality following pancreatectomy in 17,183 patients with pancreatic cancer

Ugo Marchese; Xavier Lenne; Gaanan Naveendran; Stylianos Tzedakis; Martin Gaillard; Yasmina Richa; Laurent Boyer; Didier Theis; Amelie Bruandet; Stephanie Truant; David Fuks; Mehdi El Amrani

doi:10.1016/j.hpb.2024.10.011

Nationwide analysis of one-year mortality following pancreatectomy in 17,183 patients with pancreatic cancer

HPB (Oxford). 2024 Nov 1:S1365-182X(24)02381-5. doi: 10.1016/j.hpb.2024.10.011. Online ahead of print.

Authors

Affiliations

¹ Department of Digestive, HPB and Endocrine Surgery, Cochin Hospital, AP-HP Centre, 27 rue du Faubourg St Jacques, 75014, Paris, France; Université Paris Cité, 15 rue de l'école de Médecine, 75006, Paris, France. Electronic address: ugo.marchese@aphp.fr.
² ⁠Département d'Information Médicale, CHRU de Lille, 2 Av. Oscar Lambret, 59000, Lille, France; Université de Lille, 42 rue Paul Duez, 59000, Lille, France.
³ Department of Digestive, HPB and Endocrine Surgery, Cochin Hospital, AP-HP Centre, 27 rue du Faubourg St Jacques, 75014, Paris, France; Université Paris Cité, 15 rue de l'école de Médecine, 75006, Paris, France.
⁴ School of Medicine, University College Cork, Cork, Ireland.
⁵ Département d'Information Médicale, La Timone Hospital, 264 rue Saint-Pierre, 13005, Marseille, France; Université d'Aix-Marseille, Jardin du Pharo, 58 Boulevard Charles Livon, 13007, Marseille, France.
⁶ Université de Lille, 42 rue Paul Duez, 59000, Lille, France; Department of digestive Surgery and Transplantation, CHRU de Lille, 2 Av. Oscar Lambret, 59000, Lille, France.

PMID: 39547905
DOI: 10.1016/j.hpb.2024.10.011

Abstract

Background: The use of 1-year mortality following pancreatectomy for PDAC as a measure of surgical quality has not been evaluated. We aim to i) assess the 1-year mortality rate following pancreatectomy for PDAC, and ii) identify patient and hospital characteristics associated with 1-year mortality.

Methods: Data was extracted retrospectively from the French national medico-administrative database. The study included patients who underwent pancreatectomy for PDAC between January 2012 and December 2019. The primary outcome was 1-year postoperative mortality. Hospitals were classified based on volume (high (≥26 resections/year) and low volume (<26)).

Results: Overall, 17,183 patients who underwent pancreatectomy for PDAC were included. The overall 90-day and 1-year mortalities were 6.5 % and 21.5 %, respectively. 1-year mortality varied significantly between low and high-volume hospitals (23.6 % vs. 18.6 %, respectively, p < 0.001). Older age, Charlson Comorbidity Index (CCI), readmission, major complications were predictive factors for 1-year mortality. Pancreatectomy in low volume hospitals increased the risk of 1-year mortality by 1.23-fold (OR = 1.23, 95 % CI [1.15-1.32], p < 0.001).

Conclusion: The overall 1-year mortality after pancreatectomy for PDAC was 21.5 %, and was higher in patients of older age, with higher comorbidities, who experienced major complications, and who did not receive adjuvant therapy. Management in high-volume centers decreased mortality rates, regardless of the patient's condition.