Impact of preoperative asymptomatic renal dysfunction on clinical course after pancreatoduodenectomy

Abstract

Background Although recent large-scale clinical studies have shown that preoperative renal insufficiency is associated with increased risk of postoperative complications after pancreatoduodenectomy (PD), it is unknown whether asymptomatic renal dysfunction has an impact on postoperative course after PD. Methods Two hundred and fifty-four patients who underwent PD between 2007 and 2013 were enrolled. Renal function was evaluated by the preoperative estimated glomerular filtration rate (EGFR). Patients were divided into two groups according to the cutoff value of 55 of EGFR. Results Thirty-five patients were classified as the low EGFR group, while 219 were classified as the normal group. There were differences between groups in age, comorbidity and pancreatic texture. The incidence of overall postoperative complication, grade B/C pancreatic fistula and severe complication in the low EGFR group was significantly higher than that in the normal group. Multivariate analysis identified low EGFR as an independent risk factor for severe postoperative complications and grade B/C pancreatic fistula after PD. However, there were no differences in mortality and survival between the low and normal EGFR groups. Conclusions We have demonstrated for the first time that preoperative asymptomatic renal dysfunction may be a significant risk factor for severe morbidity and clinically relevant pancreatic fistula after PD. Highlight In this first study to evaluate the impact of asymptomatic renal dysfunction on postoperative outcomes after pancreatoduodenectomy, Nagai and colleagues demonstrated that preoperative asymptomatic renal dysfunction, defined by low estimated glomerular filtration rate, may be a significant risk factor for severe morbidity and clinically relevant pancreatic fistula after pancreatoduodenectomy.