International Journal ofPancreatology, vol. 12, no. 3:219-226, December 1992 9 Copyright 1992 by The Humana Press Inc. All rights of any nature whatsoever reserved. 0169-4197/92/12/3:219-226/$2.00 Evaluation of Surgical Risk in Palliation and Resection of Pancreatic Perspective Study and Tables to Calculate the Risk Cancer Sergio Pedrazzoli, ~ Bruno Bonadimani/ Cosimo Sperti/ Claudio Pasquali/ Francesco Cappellazzo, x Sandra Catalini,~Antonio Piccoli, 2 and Carmelo Militello ~ lClinica Chirurgica; and ~Departmentof Internal Medicine, Universityof Padua, Padua, Italy Summary High morbidity and mortality rates are reported for bypass and resective surgery of pancreatic cancer. In a retrospective study we correctly predicted the postoperative course in 88% of the patients who underwent bypass surgery and 83% of those who had a resection for pancreatic cancer. Before starting with clinical application of this scoring system, we undertook a prospective study to confirm its predictive value. Sixty- seven consecutive patients with pancreatic cancer were included: 42 patients underwent bypass surgery and 25 pancreatic resections. The operative mortality was 14% for palliative surgery and 0% for resective surgery. Surgical team and nurses were totally unaware of the predicted risk. The preoperative forecast proved to be correct in 81% of bypass surgery and in 88 % of resective surgery, although surgical mortality had decreased from 21 to 14% for bypass surgery and from 17 to 0% for resective surgery. Tables are included to calculate the surgical risk for each of 162 combinations of the risk factors considered in the predictive model (81 for bypass surgery and 81 for resective surgery). Calculation of surgical risk is important when evaluating different treatments for pancreatic cancer are available. Key Words: Surgical risk; pancreatic cancer; bypass pancreatic surgery; pancreatic resection; pancreas. Introduction Exocrine pancreatic cancer is a rarely curable tumor with a very poor prognosis. In most cases (70-90%) only a bypass operation can be performed because of the advanced stage of disease (1,4,5). Received September 30, 1991; Revised January 31, 1992; Accepted March 9, 1992 *Author to whom all correspondence and reprint requests should be addressed: Clinica Chirurgica I, Universita' di Padova, Via Giustiniani, 2,35128 Padova, Italy Both radical resection and bypass surgery carry a high surgical morbidity and mortality (2-4,6-8), even though a substantial reduction of the surgical mortality has been reported after 1980, especially in resective surgery (6, 9-15). Several systems to predict surgical risk have been suggested for gastrointestinal and hepato-bilio- pancreatic diseases (16-21). The identification of reliable risk factors is useful to quantify the risk of a single patient and to stratify patients when comparing different treatments for pancreatic cancer. 210