Incidence of postoperative complications following pancreatectomy for mucinous cystic lesions versus pancreatic cancer

Abstract

Presenter: Eileen C Donovan MD | The University of Texas MD Anderson Cancer Center Background: In contrast to pancreatic cancer (PDAC), the risks of pancreatectomy for mucinous pancreatic cysts (MCs) are most often justified by reductions in malignant potential or degeneration. Despite undergoing similar operations, different rates of perioperative complications and attendant morbidity between MC and PDAC patient populations may affect recommendations for resection. We sought to identify and compare the rates of postoperative complications between patients undergoing pancreatectomies for MCs and PDAC. Methods: A prospectively maintained institutional database was used to identify patients who underwent surgical resection for MCs or PDAC from July 2011 to August 2019. The incidence of postoperative complications was quantified and compared between MC and PDAC groups. Results: 103 patients underwent surgical resection for MCs, and 428 patients underwent resection for PDAC. MC patients were more commonly female (58.3% vs. 45.6%, p = 0.021) and had higher BMIs (28.3 vs. 27.0, p = 0.029), but were similar in age to PDAC patients (61.9 years vs. 64.4 years, p = 0.241). Combined major 90-day postoperative complications, the most frequent being postoperative pancreatic fistula (POPF), abscess, and postoperative bleeding, were similar between MC and PDAC patients undergoing pancreaticoduodenectomy (PD, 32.5% vs. 20.0%, p = 0.068) or distal pancreatectomy (DP, 30.2% vs. 20.5%, p = 0.172). However, the incidence of < 90-day ISGPS Grade B or C POPF was higher in cyst patients undergoing PD (17.5% vs. 4.1%, p < 0.001), but not DP (25.4% vs. 20.4%, p = 0.473). There were no significant differences in operative time or length of stay between MCs and PDAC cohorts when segregated by procedure. Conclusion: POPFs occur more frequently and at higher grades in patients undergoing PD for MCs than for PDAC and should inform appropriate patient selection. Accordingly, the perioperative management of MC patients undergoing PD should emphasize POPF mitigation and the prevention of associated sequelae that require intervention.