Impact of Prior Abdominal Surgery on Outcomes of Pancreaticoduodenectomy

Authors

• Jason Aubrey, Corewell Health West Resident
• Shannon Smith, Corewell Health West Resident
• Pavitra Attanayake, Michigan State University College of Human Medicine Medical Student
• Joseph Mariscal, Michigan State University College of Human Medicine Medical Student
• Hannah Liefeld, Corewell Health West Resident
• Mura Assifi, Corewell Health West
• G Paul Wright, Corewell Health West
• Mathew Chung, Corewell Health West

Document Type

Conference Proceeding

Publication Date

6-2025

Publication Title

HPB

Abstract

Introduction: Pancreatic cancer remains a leading cause of cancer-related mortality worldwide, with pancreaticoduodenectomy serving as the principal surgical approach for tumors of the pancreatic head. However, this procedure is especially challenging in patients with prior abdominal surgeries due to potential adhesions and altered anatomy. Evidence on the impact of prior abdominal surgery on postoperative outcomes remains inconsistent. We aim to elucidate the influence of prior abdominal surgeries on the morbidity and mortality following pancreaticoduodenectomy.

Method: A single-center, retrospective cohort study analyzed data from patients who underwent pancreaticoduodenectomy between 2017-2024. Prior surgical history was stratified using the new Surgical Impact Score (SIS), which categorizes previous surgical interventions by increasing impact: 0 (laparoscopic pelvic surgery/no prior surgery), 1 (laparoscopic upper abdominal surgery), 2 (open abdominal surgery), and 3 (open upper abdominal surgery). Collected data included demographics, comorbidities, preoperative and surgical details, and postoperative complications. Statistical analysis employed descriptive measures and pairwise t-tests.

Results: A total of 276 patients were included (147 males, 129 females), with a mean age of 65.3 (SD 11.8) years and mean BMI of 5.2 (SD 5.2). The Surgical Impact Score (SIS) was 0 for 111 patients (40%), 1 for 96 (35%), 2 for 33 (12%), and 3 for 34 (12%). No significant differences in SIS was observed for operative duration (p = 0.697), length of stay (p = 804), postoperative pancreatic fistula (p=0.704), delayed gastric emptying (p=0.905), surgical site infection (p=0.141), intra-abdominal abscess (p=0.676), wound dehiscence (p=0.390), total parenteral nutrition requirement (p=0.628), reoperation (p=0.265), or transfusions (p=0.433). There were no 30-day mortalities in our cohort. However, higher Surgical Impact Scores were associated with significantly higher 30-day readmission rates (SIS 3: 41% vs. 17–24% in other groups, p=0.05) and higher 90-day mortality (SIS 3: 12% vs. 0–1% in other groups, p< 0.001).

Conclusion: Higher Surgical Impact Scores correlate with significantly increased 30-day readmissions and 90-day mortality, emphasizing the critical role of prior surgical history in preoperative planning. These findings highlight the importance of thorough risk assessment and patient counselling to improve outcomes in this high-risk population.

Volume

27

Issue

Suppl 2

First Page

s517

Comments

E-AHPBA (European-African Hepato-Pancreato-Biliary Association) Congress, June 10-12, Dublin, Ireland

Last Page

s517

Recommended Citation

Aubrey J, Smith S, Attanayake P, Mariscal J, Liefeld H, Assifi MM, et al. [Wright GP, Chung M]. Impact of prior abdominal surgery on outcomes of pancreaticoduodenectomy. HPB (Oxford). 2025;27(Suppl 2):S517. doi: 10.1016/j.hpb.2025.07.558.

DOI

10.1016/j.hpb.2025.07.558

ISSN

1365-182X