Influences of intraoperative warming on surgical outcomes of pancreaticoduodenectomy with portal vein reconstruction: a retrospective cohort study

Aim: To test the hypothesis that intraoperative warming (IOW) can improve surgical outcomes after pancreaticoduodenectomy with portal vein reconstruction (PD-PVR). Methods: Patients diagnosed with pancreatic head ductal adenocarcinoma who underwent PD-PVR at Huashan Hospital between January 1, 2017, and January 1, 2022, were retrospectively divided into 2 groups according to whether IOW was implemented. The primary outcome was the incidence of textbook outcome (TO) after pancreatectomy. The secondary outcomes were intraoperative hypothermia and adjuvant chemotherapy (AC) completion rate. Results: Among the 196 included patients, 122 underwent IOW while 74 did not. Both average (35.2°C vs 36.2°C, P < .001) and minimum (34.0°C vs 35.6°C, P < .001) intraoperative body temperature were significantly higher in the IOW group compared with the non-IOW one. Satisfactory surgical outcomes were observed in the IOW group, due to a higher incidence of TOs (51.4% vs 68.9%, P = .021), lower incidence of post-pancreatectomy hemorrhage (13.5% vs 3.3%, P = .010), earlier AC initiation (48 vs 40 days, P < .001), and AC completion rate (59.5% vs 76.2%, P = .020). IOW was the independent influential factor for TOs, intraoperative hypothermia, and AC completion. In survival analysis, the median overall survival was longer with AC completion (month, 8.6 vs 27.5, P < .001) or TO (month, 16.2 vs 20.0, P = .002). Intraoperative hypothermia (hazard ratio, 1.53; 95% confidence interval: 1.03–2.25, P = .033) was the independent risk factor of overall survival. Conclusions: Intraoperative hypothermia occurred frequently in patients with PD-PVR. IOW had a positive impact on surgical outcomes of PD-PVR, resulting in higher rates of TOs and postoperative AC completion.