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Double bypass for inoperable pancreatic malignancy at laparotomy: postoperative complications and long-term outcome

Lookup NU author(s): Dr Abigail Vallance, Professor Derek Manas, Dr James Prentis, Dr Christopher Snowden, Richard Charnley, Jeremy French, Bryon Jaques


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INTRODUCTION 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.

Publication metadata

Author(s): Ausania F, Vallance AE, Manas DM, Prentis JM, Snowden CP, White SA, Charnley RM, French JJ, Jaques BC

Publication type: Article

Publication status: Published

Journal: Annals of the Royal College of Surgeons of England

Year: 2012

Volume: 94

Issue: 8

Pages: 563-568

Print publication date: 01/11/2012

ISSN (print): 0035-8843

ISSN (electronic):

Publisher: Royal College of Surgeons of England


DOI: 10.1308/003588412X13373405386934


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