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01-04-2021 | Pancreatoduodenostomy | Review Article

Pancreatoduodenectomy associated with colonic resections: indications, pitfalls, and outcomes

Authors: Tommaso Giuliani, Anthony Di Gioia, Stefano Andrianello, Giovanni Marchegiani, Claudio Bassi

Published in: Updates in Surgery | Issue 2/2021

Abstract

Pancreatoduodenectomy (PD) associated with colonic resections (CR) (PD-CR) might be a viable option in case of locally advanced periampullary tumors or right colon cancer. The aim of this review was to reappraise the indications and outcomes of PD-CR focusing on the occurrence of postoperative pancreatic fistula (POPF) and colonic anastomotic leak (CAL). A systematic literature search was performed in Medline and Cochrane Central Register of Controlled Trials (CENTRAL) for studies published between 2000 and 2020 concerning PD-CR for periampullary or colonic neoplasms. Twenty-seven studies were selected. Morbidity after PD-CR ranged from 12 to 65% and surgery-related mortality was approximately 10%. When reported, the rates of POPF and AL were as high as 40% and 33%, respectively. The oncological results were strictly linked to the nature of the primary tumor and did not significantly differ from those achieved with standard resections. Surgical radicality and nodal status resulted the main determinants of outcome for pancreatic and colonic cancer, respectively. Solid evidence about the surgical outcomes of PD-CR is lacking, mainly due to the small proportion of patients undergoing such combined resection. Given the elevated surgical risk, a multidisciplinary evaluation is recommended for patient’s selection. The increasing use of neoadjuvant therapies is expected to further change the indications and outcomes of PD-CR in the next future.

Grobmyer SR, Pieracci FM, Allen PJ et al (2007) Defining morbidity after pancreaticoduodenectomy: use of a prospective complication grading system. J Am Coll Surg 204:356–364. https://doi.org/10.1016/j.jamcollsurg.2006.11.017CrossRefPubMed

Bassi C, Balzano G, Zerbi A, Ramera M (2016) Pancreatic surgery in Italy. Criteria to identify the hospital units and the tertiary referral centers entitled to perform it. Updates Surg. https://doi.org/10.1007/s13304-016-0371-2CrossRefPubMed

Kwaan MR, Al-Refaie WB, Parsons HM et al (2013) Are right-sided colectomy outcomes different from left-sided colectomy outcomes?: study of patients with colon cancer in the ACS NSQIP database. JAMA Surg 148:504–510. https://doi.org/10.1001/jamasurg.2013.1205CrossRefPubMed

Frasson M, Granero-Castro P, Ramos Rodríguez JL et al (2016) Risk factors for anastomotic leak and postoperative morbidity and mortality after elective right colectomy for cancer: results from a prospective, multicentric study of 1102 patients. Int J Colorectal Dis 31:105–114. https://doi.org/10.1007/s00384-015-2376-6CrossRefPubMed

Veyrie N, Ata T, Muscari F et al (2007) Anastomotic leakage after elective right versus left colectomy for cancer: prevalence and independent risk factors. J Am Coll Surg 205:785–793. https://doi.org/10.1016/j.jamcollsurg.2007.06.284CrossRefPubMed

Bakker IS, Grossmann I, Henneman D et al (2014) Risk factors for anastomotic leakage and leak-related mortality after colonic cancer surgery in a nationwide audit. Br J Surg 101:424–432. https://doi.org/10.1002/bjs.9395CrossRefPubMed

Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement- ClinicalKey. https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1743919110000403?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1743919110000403%3Fshowall%3Dtrue&referrer=http:%2F%2Fprisma-statement.org%2FPRISMAStatement%2FPRISMAStatement. Accessed 10 Jun 2020

Sanjay P, Takaori K, Govil S et al (2012) “Artery-first” approaches to pancreatoduodenectomy. Br J Surg 8:1027CrossRef

Paquette IM, Swenson BR, Kwaan MR et al (2012) Thirty-day outcomes in patients treated with en bloc colectomy and pancreatectomy for locally advanced carcinoma of the colon. J Gastrointest Surg 16:581–586. https://doi.org/10.1007/s11605-011-1691-7CrossRefPubMed

10.

Saiura A, Yamamoto J, Ueno M et al (2008) Long-term survival in patients with locally advanced colon cancer after en bloc pancreaticoduodenectomy and colectomy. Dis Colon Rectum 51:1548–1551. https://doi.org/10.1007/s10350-008-9318-0CrossRefPubMed

11.

Kimchi ET, Nikfarjam M, Gusani NJ et al (2009) Combined pancreaticoduodenectomy and extended right hemicolectomy: outcomes and indications. HPB 11:559–564. https://doi.org/10.1111/j.1477-2574.2009.00087.xCrossRefPubMedPubMedCentral

12.

Bhayani NH, Enomoto LM, James BC et al (2014) Multivisceral and extended resections during pancreatoduodenectomy increase morbidity and mortality. Surg (United States) 155:567–574. https://doi.org/10.1016/j.surg.2013.12.020CrossRef

13.

Harris JW, Martin JT, Maynard EC et al (2015) Increased morbidity and mortality of a concomitant colectomy during a pancreaticoduodenectomy: an NSQIP propensity-score matched analysis. HPB 17:846–854CrossRef

14.

Hartwig W, Vollmer CM, Fingerhut A et al (2014) Extended pancreatectomy in pancreatic ductal adenocarcinoma: definition and consensus of the International study group for pancreatic surgery (ISGPS). Surg (United States) 156:1–14. https://doi.org/10.1016/j.surg.2014.02.009CrossRef

15.

Hartwig W, Gluth A, Hinz U et al (2016) Outcomes after extended pancreatectomy in patients with borderline resectable and locally advanced pancreatic cancer. Br J Surg 103:1683–1694. https://doi.org/10.1002/bjs.10221CrossRefPubMed

16.

Marsman EM, de Rooij T, van Eijck CH et al (2016) Pancreatoduodenectomy with colon resection for cancer: a nationwide retrospective analysis. Surg (United States) 160:145–152. https://doi.org/10.1016/j.surg.2016.02.022CrossRef

17.

Schwartz PB, Roch AM, Han JS et al (2018) Indication for en bloc pancreatectomy with colectomy: when is it safe? Surg Endosc 32:428–435. https://doi.org/10.1007/s00464-017-5700-0CrossRefPubMed

18.

Suzuki Y, Fujino Y, Tanioka Y et al (2004) Resection of the colon simultaneously with pancreaticoduodenectomy for tumors of the pancreas and periampullary region: short-term and long-term results. World J Surg 28:1007–1010. https://doi.org/10.1007/s00268-004-7438-9CrossRefPubMed

19.

Lee DY, Schwartz JA, Wexelman B et al (2014) Outcomes of pancreaticoduodenectomy for pancreatic malignancy in octogenarians: an American college of surgeons national surgical quality improvement program analysis. Am J Surg. https://doi.org/10.1016/j.amjsurg.2013.07.042CrossRefPubMed

20.

Ağalar C, Canda AE, Unek T, Sokmen S (2017) En bloc pancreaticoduodenectomy for locally advanced right colon cancers. Int J Surg Oncol 2017:5179686. https://doi.org/10.1155/2017/5179686CrossRefPubMedPubMedCentral

21.

Alvarado-Bachmann R, Choi J, Gananadha S et al (2010) The infracolic approach to pancreatoduodenectomy for large pancreatic head tumours invading the colon. Eur J Surg Oncol. https://doi.org/10.1016/j.ejso.2010.08.132CrossRefPubMed

22.

Koea JB, Conlon K, Paty PB et al (2000) Pancreatic or duodenal resection or both for advanced carcinoma of the right colon: Is it justified? Dis Colon Rectum 43:460–465. https://doi.org/10.1007/BF02237187CrossRefPubMed

23.

Sheng QS, Bin CW, Li MJ et al (2015) Combined right hemicolectomy and pancreaticoduodenectomy for locally advanced right hemicolon cancer. Hepatobiliary Pancreat Dis Int 14:320–324. https://doi.org/10.1016/S1499-3872(15)60374-5CrossRefPubMed

24.

Kaneda Y, Noda H, Endo Y et al (2017) En bloc pancreaticoduodenectomy and right hemicolectomy for locally advanced right-sided colon cancer. World J Gastrointest Oncol. https://doi.org/10.4251/wjgo.v9.i9.372CrossRefPubMedPubMedCentral

25.

Kimchi ET, Nikfarjam M, Gusani NJ et al (2009) Combined pancreaticoduodenectomy and extended right hemicolectomy: outcomes and indications. HPB. https://doi.org/10.1111/j.1477-2574.2009.00087.xCrossRefPubMedPubMedCentral

26.

Zhang J, Leng J, Qian H et al (2013) En bloc pancreaticoduodenectomy and right colectomy in the treatment of locally advanced colon cancer. Dis Colon Rectum 56:874–880. https://doi.org/10.1097/DCR.0b013e3182941704CrossRefPubMed

27.

Solaini L, de Rooij T, Marsman EM et al (2018) Pancreatoduodenectomy with colon resection for pancreatic cancer: a systematic review. HPB 20:881–887CrossRef

28.

Khalili M, Daniels L, Gleeson EM et al (2019) Pancreaticoduodenectomy outcomes for locally advanced right colon cancers: a systematic review. Surg (United States) 166:223–229. https://doi.org/10.1016/j.surg.2019.04.020CrossRef

29.

Cirocchi R, Partelli S, Castellani E et al (2014) Right hemicolectomy plus pancreaticoduodenectomy vs partial duodenectomy in treatment of locally advanced right colon cancer invading pancreas and/or only duodenum. Surg Oncol 23:92–98CrossRef

30.

Aǧalar C, Canda AE, Unek T, Sokmen S (2017) En bloc pancreaticoduodenectomy for locally advanced right colon cancers. Int J Surg Oncol. https://doi.org/10.1155/2017/5179686CrossRefPubMedPubMedCentral

31.

Temple SJ, Kim PTW, Serrano PE et al (2014) Combined pancreaticoduodenectomy and colon resection for locally advanced peri-ampullary tumours: analysis of peri-operative morbidity and mortality. HPB 16:797–800. https://doi.org/10.1111/hpb.12263CrossRefPubMedPubMedCentral

32.

Kapoor S, Das B, Pal S et al (2006) En bloc resection of right-sided colonic adenocarcinoma with adjacent organ invasion. Int J Colorectal Dis. https://doi.org/10.1007/s00384-005-0756-zCrossRefPubMed

33.

Suzuki Y, Fujino Y, Tanioka Y et al (2004) Resection of the colon simultaneously with pancreaticoduodenectomy for tumors of the pancreas and periampullary region: short-term and long-term results. World J Surg. https://doi.org/10.1007/s00268-004-7438-9CrossRefPubMed

34.

Lee W-S, Lee WY, Chun H-K, Choi S-H (2009) En bloc resection for right colon cancer directly invading duodenum or pancreatic head. Yonsei Med J 50:803–806. https://doi.org/10.3349/ymj.2009.50.6.803CrossRefPubMedPubMedCentral

35.

Li D, Si X, Wan T, Zhou Y (2018) A pooled analysis of en bloc right hemicolectomy with pancreaticoduodenectomy for locally advanced right-sided colon cancer. Int J Colorectal Dis. https://doi.org/10.1007/s00384-018-2997-7CrossRefPubMed

36.

Shubert CR, Bergquist JR, Groeschl RT et al (2016) Overall survival is increased among stage III pancreatic adenocarcinoma patients receiving neoadjuvant chemotherapy compared to surgery first and adjuvant chemotherapy: an intention to treat analysis of the National Cancer Database. Surgery (United States) 160:1080

37.

Michelakos T, Pergolini I, Del CCF et al (2019) Predictors of resectability and survival in patients with borderline and locally advanced pancreatic cancer who underwent neoadjuvant treatment with FOLFIRINOX. Ann Surg. https://doi.org/10.1097/SLA.0000000000002600CrossRefPubMed

38.

Choi JG, Nipp RD, Tramontano A et al (2019) Neoadjuvant FOLFIRINOX for patients with borderline resectable or locally advanced pancreatic cancer: results of a decision analysis. Oncologist. https://doi.org/10.1634/theoncologist.2018-0114CrossRefPubMedPubMedCentral

39.

Hakimi AN, Rosing DK, Stabile BE, Petrie BA (2007) En Bloc resection of the duodenum for locally advanced right colon adenocarcinoma. Am Surg 73:1063CrossRef

40.

Curley SA, Carlson GW, Shumate CR et al (1992) Extended resection for locally advanced colorectal carcinoma. Am J Surg. https://doi.org/10.1016/0002-9610(92)90554-5CrossRefPubMed

41.

Minni F, Casadei R, Marrano N et al (2005) Second tumours in patients with malignant neoplasms of the digestive apparatus. A retrospective study on 2406 cases. Ann Ital Chir 76:467PubMed

42.

Brinster DR, Raper SE (2004) Synchronous colon and pancreatic cancers in a patient with Peutz-Jeghers syndrome: report of a case and review of the literature. Surgery. https://doi.org/10.1016/S0039-6060(03)00379-9CrossRefPubMed

43.

Andrianello S, Marchegiani G, Malleo G et al (2017) Biliary fistula after pancreaticoduodenectomy: data from 1618 consecutive pancreaticoduodenectomies. HPB. https://doi.org/10.1016/j.hpb.2016.11.011CrossRefPubMed

44.

Pulvirenti A, Marchegiani G, Pea A et al (2017) Clinical implications of the 2016 international study group on pancreatic surgery definition and grading of postoperative pancreatic fistula on 775 consecutive pancreatic resections. Ann Surg. https://doi.org/10.1097/SLA.0000000000002362CrossRefPubMed

45.

Bassi C, Marchegiani G, Dervenis C et al (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surg (United States). https://doi.org/10.1016/j.surg.2016.11.014CrossRefPubMedCentral

46.

Catarci M, Ruffo G, Borghi F et al (2020) Anastomotic leakage after elective colorectal surgery: a prospective multicentre observational study on use of the Dutch leakage score, serum procalcitonin and serum C-reactive protein for diagnosis. BJS Open 4:499–507. https://doi.org/10.1002/bjs5.50269CrossRef

47.

Molinari E, Giuliani T, Andrianello S et al (2020) Drain fluid’s pH predicts anastomotic leak in colorectal surgery: results of a prospective analysis of 173 patients. Minerva Chir 75:30–36. https://doi.org/10.23736/S0026-4733.19.08018-0CrossRefPubMed

48.

Riemann A, Wußling H, Loppnow H et al (2016) Acidosis differently modulates the inflammatory program in monocytes and macrophages. Biochim Biophys Acta Mol Basis Dis. https://doi.org/10.1016/j.bbadis.2015.10.017CrossRef

49.

Andrianello S, Marchegiani G, Bannone E et al (2018) Clinical implications of intraoperative fluid therapy in pancreatic surgery. J Gastrointest Surg 22:2072–2079. https://doi.org/10.1007/s11605-018-3887-6CrossRefPubMed

50.

Bannone E, Andrianello S, Marchegiani G et al (2018) Postoperative acute pancreatitis following pancreaticoduodenectomy a determinant of fistula potentially driven by the intraoperative fluid management. Ann Surg 268:815–822. https://doi.org/10.1097/SLA.0000000000002900CrossRefPubMed

51.

Callery MP, Pratt WB, Kent TS et al (2013) A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg 216:1–14. https://doi.org/10.1016/j.jamcollsurg.2012.09.002CrossRefPubMed

52.

Andrianello S, Marchegiani G, Anselmi B et al (2018) Polyester preserves the highest breaking point after prolonged incubation in pancreatic juice. J Gastrointest Surg 22:444–450. https://doi.org/10.1007/s11605-017-3558-zCrossRefPubMed

53.

Zhang B, Lee GC, Qadan M et al (2019) Revision of pancreatic neck margins based on intraoperative frozen section analysis is associated with improved survival in patients undergoing pancreatectomy for ductal adenocarcinoma. Ann Surg. https://doi.org/10.1097/sla.0000000000003503CrossRefPubMedPubMedCentral

54.

Kulemann B, Hoeppner J, Wittel U et al (2015) Perioperative and long-term outcome after standard pancreaticoduodenectomy, additional portal vein and multivisceral resection for pancreatic head cancer. J Gastrointest Surg. https://doi.org/10.1007/s11605-014-2725-8CrossRefPubMed

55.

McKay A, Sutherland FR, Bathe OF, Dixon E (2008) Morbidity and mortality following multivisceral resections in complex hepatic and pancreatic surgery. J Gastrointest Surg. https://doi.org/10.1007/s11605-007-0273-1CrossRefPubMed

56.

Zhang J, Leng JH, Qian HG et al (2013) En bloc pancreaticoduodenectomy and right colectomy in the treatment of locally advanced colon cancer. Dis Colon Rectum. https://doi.org/10.1097/DCR.0b013e3182941704CrossRefPubMed

57.

Costa SRP, Henriques AC, Horta SHC et al (2009) En-bloc pancreatoduodenectomy and right hemicolectomy for treating locally advanced right colon cancer (T4): a series of five patients. Arq Gastroenterol 46:151–153. https://doi.org/10.1590/S0004-28032009000200014CrossRefPubMed

58.

Mora-Pinzon MC, Francescatti AB, Luu MB et al (2013) En bloc right hemicolectomy/pancreaticoduodenectomy for cancer: one institution’s experience. Am Surg 79:238CrossRef

Title: Pancreatoduodenectomy associated with colonic resections: indications, pitfalls, and outcomes
Authors: Tommaso Giuliani
Anthony Di Gioia
Stefano Andrianello
Giovanni Marchegiani
Claudio Bassi
Publication date: 01-04-2021
Publisher: Springer International Publishing
Keywords: Pancreatoduodenostomy
Pancreatectomy
Colectomy
Pancreatoduodenostomy
Colectomy
Hemicolectomy
Hemicolectomy
Published in: Updates in Surgery / Issue 2/2021
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-021-00996-7

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Pancreatoduodenectomy associated with colonic resections: indications, pitfalls, and outcomes

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