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Indication for en bloc pancreatectomy with colectomy: when is it safe?

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Abstract

Introduction

Aggressive en bloc resection of adjacent organs is often necessary to resect pancreatic or colonic lesions. However, it is debated whether simultaneous pancreatectomy with colectomy (P+C) is warranted as it potentially increases morbidity and mortality (MM). We hypothesized that MM would be increased in P+C, especially in cases of pancreatitis.

Methods

All patients who underwent pancreatectomy (P) and simultaneous pancreatectomy with colectomy (P+C) at a high-volume center from November 2006 to 2015 were prospectively collected using ACS-NSQIP at our institution. Patients with additional multivisceral or enucleation procedures were excluded. Data were augmented to 90-day outcomes using our institutional database.

Results

Forty-three patients with a mean age of 62 years (27:16 male: female) underwent P+C, accounting for 2.39% (43/1797) of pancreatectomies performed. Pancreatoduodenectomy (PD) was performed in 61% (n = 26), distal pancreatectomy (DP) in 37% (n = 16), and total pancreatectomy (TP) in 2% (n = 1) of patients. The 30- and 90-day MM were higher in P+C than P (30-day: 54 vs. 37%, p = 0.037 and 9 vs. 2%, p = 0.022; 90-day: 61 vs. 42%, p = 0.019 and 14 vs. 3%, p = 0.002). Logistical regression modeling revealed an association between 90-day mortality and colectomy (p = 0.013, OR = 3.556). When P+C MM were analyzed according to intraoperative factors, there was no significant difference according to type of pancreatectomy (PD vs. DP vs. TP), origin of primary lesion (pancreas vs. colon), surgical indication (malignant vs. non-malignant), or case status (planned colectomy vs. intraoperative decision).

Conclusions

Addition of colectomy to pancreatectomy substantially increased MM. Subanalysis revealed that type of resection performed, etiology, and planning status did not account for increased risk when performing P+C. However, colectomy was found to be an independent risk factor for mortality. Therefore, patients should be informed of the risk of increased postoperative complications until a further study can identify potential patients or perioperative factors that can be used for risk stratification.

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Abbreviations

ACS-NSQIP:

American College of Surgeons National Surgical Quality Improvement Program

P:

Pancreatectomy

P+C:

Pancreatectomy with colectomy

ASA:

American Society of Anesthesiologists

BMI:

Body mass index

PD:

Pancreatoduodenectomy

TP:

Total pancreatectomy

DP:

Distal pancreatectomy

SSI:

Surgical site infection

VTE:

Venous thromboembolism

MI:

Myocardial infarction

POPF:

Postoperative pancreatic fistula

MM:

Morbidity and mortality

OR:

Odds ratio

CI:

Confidence interval

References

  1. Cameron JL, He J (2015) Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg. doi:10.1016/j.jamcollsurg.2014.12.031

    PubMed Central  Google Scholar 

  2. Sohn TA, Yeo CJ, Cameron JL, Koniaris L, Kaushal S, Abrams RA, Sauter PK, Coleman J, Hruban RH, Lillemoe KD (2000) Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg. doi:10.1111/hpb.12263

    Google Scholar 

  3. Temple SJ, Kim PT, Serrano PE, Kagedan D, Cleary SP, Moulton CA, McGilvray ID, Gallinger S, Greig PD, Wei AC (2014) Combined pancreaticoduodenectomy and colon resection for locally advanced peri-ampullary tumours: analysis of peri-operative morbidity and mortality. HPB. doi:10.1111/hpb.12263

    PubMed Central  Google Scholar 

  4. Harris JW, Martin JT, Maynard EC, McGrath PC, Tzeng CW (2015) Increased morbidity and mortality of a concomitant colectomy during a pancreaticoduodenectomy: an NSQIP propensity-score matched analysis. HPB. doi:10.1111/hpb.12471

    PubMed  PubMed Central  Google Scholar 

  5. Qian ZY, Miao Y, Dai CC, Xu ZK, Liu XL (2005) Combined multiple organ resection in 16 patients with adenocarcinoma of the body or tail of the pancreas. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 27(5):572–574

    PubMed  Google Scholar 

  6. Bhayani NH, Enomoto LM, James BC, Ortenzi G, Kaifi JT, Kimchi ET, Staveley-O’Carroll KF, Gusani NJ (2014) Multivisceral and extended resections during pancreatoduodenectomy increase morbidity and mortality. Surgery. doi:10.1016/j.surg.2013.12.020

    PubMed  Google Scholar 

  7. Paquette IM, Swenson BR, Kwaan MR, Mellgren AF, Madoff RD (2012) Thirty-day outcomes in patients treated with en bloc colectomy and pancreatectomy for locally advanced carcinoma of the colon. J Gastrointest Surg. doi:10.1007/s11605-011-1691-7

    PubMed  Google Scholar 

  8. Parikh P, Shiloach M, Cohen ME, Bilimoria KY, Ko CY, Hall BL, Pitt HA (2010) Pancreatectomy risk calculator: an ACS-NSQIP resource. HPB 12(7):488–497

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ball CG, Pitt HA, Kilbane ME, Dixon E, Sutherland FR, Lillemoe KD (2010) Peri-operative blood transfusion and operative time are quality indicators for pancreatoduodenectomy. HPB 12(7):465–471

    Article  PubMed  PubMed Central  Google Scholar 

  10. Parikh JA, Beane JD, Kilbane EM, Milgrom DP, Pitt HA (2014) Is American College of Surgeons NSQIP organ space infection a surrogate for pancreatic fistula? J Am Coll Surg. doi:10.1016/j.jamcollsurg.2014.08.006

    Google Scholar 

  11. Beane JD, House MG, Pitt SC, Kilbane EM, Hall BL, Parmar AD, Riall TS, Pitt HA (2015) Distal pancreatectomy with celiac axis resection: what are the added risks? HPB. doi:10.1111/hpb.12453

    PubMed  PubMed Central  Google Scholar 

  12. Cooper AB, Parmar AD, Riall TS, Hall BL, Katz MH, Aloia TA, Pitt HA (2015) Does the use of neoadjuvant therapy for pancreatic adenocarcinoma increase postoperative morbidity and mortality rates? J Gastrointest Surg. doi:10.1007/s11605-014-2620-3

    PubMed  Google Scholar 

  13. Tamirisa NP, Parmar AD, Vargas GM, Mehta HB, Kilbane EM, Hall BL, Pitt HA, Riall TS (2016) Relative contributions of complications and failure to rescue on mortality in older patients undergoing pancreatectomy. Ann Surg 263(2):385–391

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr. EH541, Indianapolis, IN, 46202, USA

    Patrick B. Schwartz, Alexandra M. Roch, Jane S. Han, Alex V. Vaicius, William P. Lancaster, E. Molly Kilbane, Michael G. House, Nicholas J. Zyromski, C. Max Schmidt, Atilla Nakeeb & Eugene P. Ceppa

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  1. Patrick B. Schwartz
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  2. Alexandra M. Roch
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  3. Jane S. Han
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  4. Alex V. Vaicius
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  6. E. Molly Kilbane
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  7. Michael G. House
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  11. Eugene P. Ceppa
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Corresponding author

Correspondence to Eugene P. Ceppa.

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Disclosures

Patrick B. Schwartz, Alexandra M. Roch, Jane S. Han, Alex V. Vaicius, William P. Lancaster, E. Molly Kilbane, Michael G. House, Nicholas J. Zyromski, C. Max Schmidt, Atilla Nakeeb, Eugene P. Ceppa have no conflicts of interest or financial ties to disclose.

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Schwartz, P.B., Roch, A.M., Han, J.S. et al. Indication for en bloc pancreatectomy with colectomy: when is it safe?. Surg Endosc 32, 428–435 (2018). https://doi.org/10.1007/s00464-017-5700-0

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  • DOI: https://doi.org/10.1007/s00464-017-5700-0

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