Postoperative complications after pancreatoduodenectomy for malignancy: results from the Recurrence After Whipple’s (RAW) study

Background Pancreatoduodenectomy (PD) is associated with significant postoperative morbidity. Surgeons should have a sound understanding of the potential complications for consenting and benchmarking purposes. Furthermore, preoperative identification of high-risk patients can guide patient selection and potentially allow for targeted prehabilitation and/or individualized treatment regimens. Using a large multicentre cohort, this study aimed to calculate the incidence of all PD complications and identify risk factors. Method Data were extracted from the Recurrence After Whipple’s (RAW) study, a retrospective cohort study of PD outcomes (29 centres from 8 countries, 2012–2015). The incidence and severity of all complications was recorded and potential risk factors for morbidity, major morbidity (Clavien–Dindo grade > IIIa), postoperative pancreatic fistula (POPF), post-pancreatectomy haemorrhage (PPH) and 90-day mortality were investigated. Results Among the 1348 included patients, overall morbidity, major morbidity, POPF, PPH and perioperative death affected 53 per cent (n = 720), 17 per cent (n = 228), 8 per cent (n = 108), 6 per cent (n = 84) and 4 per cent (n = 53), respectively. Following multivariable tests, a high BMI (P = 0.007), an ASA grade > II (P II patients were at increased risk of major morbidity (P < 0.0001), and a raised BMI correlated with a greater risk of POPF (P = 0.001). Conclusion In this multicentre study of PD outcomes, an ASA grade > II was a risk factor for major morbidity and a high BMI was a risk factor for POPF. Patients who are preoperatively identified to be high risk may benefit from targeted prehabilitation or individualized treatment regimens

Environmental factors influencing larval sprat Sprattus sprattus feeding during spawning time in the Baltic Sea

The management of Baltic sprat is challenged by highly variable recruitment success and hence large stock fluctuations. Recent studies have identified the larval and early juvenile life stages to be critical for the survival rate of a sprat year class. Although prey abundance was found to be linked to larval survival success, an analysis identifying the functional relationship and relative importance of other environmental factors is still missing. Sprat larval feeding was investigated in 2002 during three cruises, covering the main spawning time in the Bornholm Basin, Baltic Sea. The aim of the study was to identify the key environmental factors determining the feeding success of larval sprat taking their potential interactions explicitly into account. An extension of generalized additive models (GAMs) was adopted that allows the inclusion of interaction terms in a non-parametric regression model. The final model of sprat larval feeding success explained ∼80% of the variance in the data and was based on the following environmental factors: bottom depth, cubed wind speed as proxy for small-scale turbulence rates, degree of cloudiness as proxy for light conditions and prey density in combination with a feeding period–cloudiness interaction term. Our study demonstrates that the feeding success of sprat larvae in the Baltic Sea is controlled by a number of simultaneously acting key environmental factor