Association Between Postoperative Complications Assessed by the Comprehensive Complication Index (CCI) and Early Recurrence after Pancreaticoduodenectomy for Biliary Tract Cancer

Abstract

Background

This study aimed to evaluate the impact of postoperative complications on early recurrence (ER) after pancreaticoduodenectomy (PD) for biliary tract cancer (BTC).

Methods

Patients who underwent PD for BTC between 2009 and 2022 were enrolled in this study. Postoperative complications were assessed using the comprehensive complication index (CCI), calculated by summing all the complications. The optimal CCI cutoff value for predicting ER was selected based on the minimum P value from the chi-square test. ER was defined as recurrence within 12 months of resection. Risk factors for ER were identified using multivariate analysis.

Results

A total of 118 patients were analyzed. ER was observed in 34 (28.8 %) patients, indicating a significantly poorer prognosis than those without ER (log-rank, P < .001). No significant differences were observed in the primary tumor site or pathological features between the low CCI (<42.6) and high CCI (≥42.6) groups. The incidence of ER was significantly higher in the high CCI group than in the low CCI group (50.0% vs 24.0%, P = .015). Multivariate analysis revealed that high CCI (odds ratio [OR] 4.43, 95% confidence interval [CI] 1.41-13.97, P = .011) and R1 resection (OR 4.88, 95% CI 1.43-16.70, P = .012) were independent risk factors for ER.

Discussion

Postoperative complications after PD for BTC were found to be independent risk factors for ER.

Keywords

biliary tract cancer pancreaticoduodenectomy comprehensive complication index postoperative complication early recurrence

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