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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 9/2018

01-09-2018 | Original Article

Distal Pancreatectomy Combined with Multivisceral Resection Is Associated with Postoperative Complication Rates and Survival Comparable to Those After Standard Procedures

Authors: Thomas Malinka, Fritz Klein, Andreas Andreou, Johann Pratschke, Marcus Bahra

Published in: Journal of Gastrointestinal Surgery | Issue 9/2018

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Abstract

Background

For pancreatic tumors located in the body or tail of the pancreas, distal pancreatectomy (DP) remains the surgical procedure of choice to achieve radical tumor removal. Purpose of this study was to evaluate outcome and overall survival of patients who underwent DP combined with multivisceral resection (MVR).

Methods

Retrospective single-center case-matched analysis. Between January 1994 and June 2014, 494 consecutive patients were entered into a prospective database, and 126 patients undergoing DP + MVR (cases) were matched with 126 patients undergoing DP (controls) for gender, age, and underlying final diagnosis.

Results

There were no significant differences in patient demographics. Rates of postoperative pancreatic fistula (POPF) (36 (28.6%) vs. 29 (23.0%); p = 0.388) and postpancreatectomy hemorrhage (PPH) (7 (5.5%) vs. 5 (3.9%); p = 0.769) did not reveal any significant differences. Although operative time (237.8 ± 57.9 vs. 203.5 ± 34.5; p < 0.001) and the necessity for intraoperative transfusions (18 (14.3%) vs. 5 (4.0%); p < 0.001) was significantly higher, the number of patients with major complications (the Clavien-Dindo ≥ 3) was not increased (27 (19.8%) vs. 20 (15.9%); p = 0.332) in the DP + MVR group. Midterm survival analysis indicated no significant difference for adenocarcinoma and neuroendocrine tumors for either group.

Conclusion

DP + MVR is a feasible and safe surgical procedure to achieve radical tumor removal and can offer beneficial survival outcomes. Although operative time and intraoperative transfusions are enhanced, POPF, PPH, or major complications (the Clavien-Dindo ≥ 3) are not significantly increased after DP + MVR. DP + MVR can therefore be recommended in selected patients for resection of extended tumors within the concept of interdisciplinary strategies.
Literature
1.
Paye F, Micelli Lupinacci R, Bachellier P, Boher JM, Delpero JR, French Surgical A. Distal pancreatectomy for pancreatic carcinoma in the era of multimodal treatment. Br J Surg. 2015;102(3):229–36.CrossRefPubMed
2.
de Rooij T, Tol JA, van Eijck CH, Boerma D, Bonsing BA, Bosscha K, van Dam RM, Dijkgraaf MG, Gerhards MF, van Goor H, van der Harst E, de Hingh IH, Kazemier G, Klaase JM, Molenaar IQ, Patijn GA, van Santvoort HC, Scheepers JJ, van der Schelling GP, Sieders E, Busch OR, Besselink MG, Dutch Pancreatic Cancer G. Outcomes of Distal Pancreatectomy for Pancreatic Ductal Adenocarcinoma in the Netherlands: A Nationwide Retrospective Analysis. Ann Surg Oncol. 2016;23(2):585–91.CrossRefPubMed
3.
Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ. Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg. 1999;229(5):693–8; discussion 8-700.CrossRefPubMedPubMedCentral
4.
5.
Ruess DA, Makowiec F, Chikhladze S, Sick O, Riediger H, Hopt UT, Wittel UA. The prognostic influence of intrapancreatic tumor location on survival after resection of pancreatic ductal adenocarcinoma. BMC Surg. 2015;15:123.CrossRefPubMedPubMedCentral
6.
Hartwig W, Vollmer CM, Fingerhut A, Yeo CJ, Neoptolemos JP, Adham M, Andren-Sandberg A, Asbun HJ, Bassi C, Bockhorn M, Charnley R, Conlon KC, Dervenis C, Fernandez-Cruz L, Friess H, Gouma DJ, Imrie CW, Lillemoe KD, Milicevic MN, Montorsi M, Shrikhande SV, Vashist YK, Izbicki JR, Buchler MW, International Study Group on Pancreatic S. Extended pancreatectomy in pancreatic ductal adenocarcinoma: definition and consensus of the International Study Group for Pancreatic Surgery (ISGPS). Surgery. 2014;156(1):1–14.CrossRefPubMed
7.
8.
Hirono S, Kawai M, Tani M, Okada K, Miyazawa M, Shimizu A, Kitahata Y, Yamaue H. Indication for the use of an interposed graft during portal vein and/or superior mesenteric vein reconstruction in pancreatic resection based on perioperative outcomes. Langenbecks Arch Surg. 2014;399(4):461–71.CrossRefPubMed
9.
Kulemann B, Hoeppner J, Wittel U, Glatz T, Keck T, Wellner UF, Bronsert P, Sick O, Hopt UT, Makowiec F, Riediger H. Perioperative and long-term outcome after standard pancreaticoduodenectomy, additional portal vein and multivisceral resection for pancreatic head cancer. J Gastrointest Surg. 2015;19(3):438–44.CrossRefPubMed
10.
Bhayani NH, Enomoto LM, James BC, Ortenzi G, Kaifi JT, Kimchi ET, Staveley-O’Carroll KF, Gusani NJ. Multivisceral and extended resections during pancreatoduodenectomy increase morbidity and mortality. Surgery. 2014;155(3):567–74.CrossRefPubMed
11.
Panzeri F, Marchegiani G, Malleo G, Malpaga A, Maggino L, Marchese T, Salvia R, Bassi C, Butturini G. Distal pancreatectomy associated with multivisceral resection: results from a single centre experience. Langenbecks Arch Surg. 2017;402(3):457–64.CrossRefPubMed
12.
Denecke T, Andreou A, Podrabsky P, Grieser C, Warnick P, Bahra M, Klein F, Hamm B, Neuhaus P, Glanemann M. Distal pancreatectomy with en bloc resection of the celiac trunk for extended pancreatic tumor disease: an interdisciplinary approach. Cardiovasc Intervent Radiol. 2011;34(5):1058–64.CrossRefPubMed
13.
Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Buchler MW. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142(1):20–5.CrossRefPubMed
14.
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula D. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8–13.CrossRefPubMed
15.
McPhee JT, Hill JS, Whalen GF, Zayaruzny M, Litwin DE, Sullivan ME, Anderson FA, Tseng JF. Perioperative mortality for pancreatectomy: a national perspective. Ann Surg. 2007;246(2):246–53.CrossRefPubMedPubMedCentral
16.
Sun J, Yang Y, Wang X, Yu Z, Zhang T, Song J, Zhao H, Wen J, Du Y, Lau WY, Zhang Y. Meta-analysis of the efficacies of extended and standard pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas. World J Surg. 2014;38(10):2708–15.CrossRefPubMed
17.
Irani JL, Ashley SW, Brooks DC, Osteen RT, Raut CP, Russell S, Swanson RS, Whang EE, Zinner MJ, Clancy TE. Distal pancreatectomy is not associated with increased perioperative morbidity when performed as part of a multivisceral resection. J Gastrointest Surg. 2008;12(12):2177–82.CrossRefPubMed
18.
19.
20.
Krautz C, Nimptsch U, Weber GF, Mansky T, Grutzmann R. Effect of Hospital Volume on In-hospital Morbidity and Mortality Following Pancreatic Surgery in Germany. Ann Surg. 2017.
21.
Fong Y, Gonen M, Rubin D, Radzyner M, Brennan MF. Long-Term Survival Is Superior After Resection for Cancer in High-Volume Centers. Transactions of the Meeting of the American Surgical Association. 2005;123(&NA;):234–41.CrossRef
22.
Fahy BN, Frey CF, Ho HS, Beckett L, Bold RJ. Morbidity, mortality, and technical factors of distal pancreatectomy. Am J Surg. 2002;183(3):237–41.CrossRefPubMed
23.
Kleeff J, Diener MK, Z’Graggen K, Hinz U, Wagner M, Bachmann J, Zehetner J, Muller MW, Friess H, Buchler MW. Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg. 2007;245(4):573–82.CrossRefPubMedPubMedCentral
24.
Zhang H, Zhu F, Shen M, Tian R, Shi CJ, Wang X, Jiang JX, Hu J, Wang M, Qin RY. Systematic review and meta-analysis comparing three techniques for pancreatic remnant closure following distal pancreatectomy. Br J Surg. 2015;102(1):4–15.CrossRefPubMed
25.
Diener MK, Seiler CM, Rossion I, Kleeff J, Glanemann M, Butturini G, Tomazic A, Bruns CJ, Busch ORC, Farkas S, Belyaev O, Neoptolemos JP, Halloran C, Keck T, Niedergethmann M, Gellert K, Witzigmann H, Kollmar O, Langer P, Steger U, Neudecker J, Berrevoet F, Ganzera S, Heiss MM, Luntz SP, Bruckner T, Kieser M, Büchler MW. Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. The Lancet. 2011;377(9776):1514–22.CrossRef
26.
Klein F, Sauer IM, Pratschke J, Bahra M. Bovine Serum Albumin-Glutaraldehyde Sealed Fish-Mouth Closure of the Pancreatic Remnant during Distal Pancreatectomy. HPB Surg. 2017;2017:9747421.CrossRefPubMedPubMedCentral
27.
GLOBOCAN. European age-standardised rates calculated by the statistical information team at cancer research UK. 2011 using data from GLOBOCAN 2008 v1.2, IARC, version 1 2. Available at: http://​globocan.​iarc.​fr.
28.
Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA, Asbun HJ, Bassi C, Buchler M, Charnley RM, Conlon K, Cruz LF, Dervenis C, Fingerhutt A, Friess H, Gouma DJ, Hartwig W, Lillemoe KD, Montorsi M, Neoptolemos JP, Shrikhande SV, Takaori K, Traverso W, Vashist YK, Vollmer C, Yeo CJ, Izbicki JR, International Study Group of Pancreatic S. Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2014;155(6):977–88.CrossRefPubMed
29.
Schorn S, Demir IE, Reyes CM, Saricaoglu C, Samm N, Schirren R, Tieftrunk E, Hartmann D, Friess H, Ceyhan GO. The impact of neoadjuvant therapy on the histopathological features of pancreatic ductal adenocarcinoma—A systematic review and meta-analysis. Cancer Treat Rev. 2017;55:96–106.CrossRefPubMed
Metadata
Title
Distal Pancreatectomy Combined with Multivisceral Resection Is Associated with Postoperative Complication Rates and Survival Comparable to Those After Standard Procedures
Authors
Thomas Malinka
Fritz Klein
Andreas Andreou
Johann Pratschke
Marcus Bahra
Publication date
01-09-2018
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 9/2018
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-018-3804-z

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