HPB P39 Pre-operative Cardiopulmonary Exercise test as a Predictive tool for post pancreaticoduodenectomy intra-abdominal collection development. A Retrospective study

Abstract

Abstract Background Cardiopulmonary Exercise Test (CPET) provides a non-invasive assessment tool for physiological fitness and peri-operative mortality in major abdominal surgery including Pancreaticoduodenectomy (PD). Post-operative complications including intra-abdominal collection could potentially delay adjuvant chemotherapy following PD. There is minimal evidence in the literature to link CPET derived variables to post PD complications. The aim of this study is to evaluate the role of CPET in predicting post operative intra-abdominal collection. Methods A retrospective single centre analysis of a prospectively maintained database from 2016 to 2021 for all patients who had PD was performed. Patient demographics, co-morbidities, and CPET variables were collected. Post-operative adverse events including Clavien-Dindo (CD) grade III intraabdominal collection, length of hospital stay and Readmission within 1 year were looked at. P value ≤ 0.05 was considered statistically significant. Results 143 patients had PD during the study period. CPET was performed in 30 patients (21%). The patients’ age was 67 ±9 (Mean±SD). Forty patients (28.2%) had developed Intra-abdominal collection CDIII. In the CPET subgroup, Anaerobic Threshold (AT) ≤ 14 on CPET was a risk factor to develop intra-abdominal collection CDIII in univariate analysis (60% Vs 9%, Chi2, p 0.02) and multivariate analysis (HR 3.5, 95% CI 1.6-657, p 0.02). Another significant risk factor was a post-operative pancreatic leak (POPF) (40% Vs 22%, Chi2, p 0.04). Conclusions Patients who have Anaerobic Threshold ≤ 14 on CPET, are more likely to develop intra-abdominal collection requiring drainage after Pancreaticoduodenectomy. This group of patients will be less likely to start chemotherapy early.