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Double bypass for inoperable pancreatic malignancy at laparotomy: postoperative complications and long-term outcome Ausania F; Vallance AE; Manas DM; Prentis JM; Snowden CP; White SA; Charnley RM; French JJ; Jaques BCAnn R Coll Surg Engl 2012[Nov]; 94 (8): 563-8INTRODUCTION: Between 4% and 13% of patients with operable pancreatic malignancy are found unresectable at the time of surgery. Double bypass is a good option for fit patients but it is associated with a high risk of postoperative complications. The aim of this study was to identify pre-operatively which patients undergoing double bypass are at high risk of complications and to assess their long-term outcome. METHODS: Of the 576 patients undergoing pancreatic resections between 2006 and 2011, 50 patients who underwent a laparotomy for a planned pancreaticoduodenectomy had a double bypass procedure for inoperable disease. Demographic data, risk factors for postoperative complications and pre-operative anaesthetic assessment data including the Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) and cardiopulmonary exercise testing (CPET) were collected. RESULTS: Fifty patients (33 men and 17 women) were included in the study. The median patient age was 64 years (range: 39-79 years). The complication rate was 50% and the in-hospital mortality rate was 4%. The P-POSSUM physiology subscore and low anaerobic threshold at CPET were significantly associated with postoperative complications (p =0.005 and p =0.016 respectively) but they were unable to predict them. Overall long-term survival was significantly shorter in patients with postoperative complications (9 vs 18 months). Postoperative complications were independently associated with poorer long-term survival (p =0.003, odds ratio: 3.261). CONCLUSIONS: P-POSSUM and CPET are associated with postoperative complications but the possibility of using them for risk prediction requires further research. However, postoperative complications following double bypass have a significant impact on long-term survival and this type of surgery should therefore only be performed in specialised centres.|Adult[MESH]|Anastomosis, Roux-en-Y/methods[MESH]|Female[MESH]|Gastroenterostomy/methods[MESH]|Humans[MESH]|Length of Stay[MESH]|Male[MESH]|Middle Aged[MESH]|Palliative Care/methods[MESH]|Pancreatic Neoplasms/*surgery[MESH]|Pancreaticoduodenectomy/*methods[MESH]|Postoperative Complications/*etiology[MESH]|Preoperative Care/methods[MESH]|Prospective Studies[MESH]|Risk Assessment[MESH]|Stents[MESH]|Survival Analysis[MESH]|Treatment Outcome[MESH]|Young Adult[MESH] |
