Distal pancreatectomy associated with multivisceral resection: results from a single centre experience

Panzeri, Francesca; Marchegiani, Giovanni; Malleo, Giuseppe; Malpaga, Anna; Maggino, Laura; Marchese, Tiziana; Salvia, Roberto; Bassi, Claudio; Butturini, Giovanni

doi:10.1007/s00423-016-1514-0

Cited by 25 publications

(14 citation statements)

References 32 publications

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“…In summary, multivisceral resections in general were associated with increased morbidity and the risk of reoperation, but not with increased short- or long-term mortality. Although there are currently no meta-analyses on the matter, a large multi-center study by Paye et al and previously published single-center reports support our observations [ 10 , 11 , 27 – 30 ]. Of note, most of these publications included resections for different types of pancreatic tumors, whereas the current study focused explicitly on histologically confirmed pancreatic ductal adenocarcinoma.…”

Section: Discussionsupporting

confidence: 86%

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Multivisceral resection for adenocarcinoma of the pancreatic body and tail—a retrospective single-center analysis

et al. 2020

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Background Adenocarcinoma of the pancreatic body and tail is associated with a dismal prognosis. As patients frequently present themselves with locally advanced tumors, extended surgery including multivisceral resection is often necessary in order to achieve tumor-free resection margins. The aim of this study was to identify prognostic factors for postoperative morbidity and mortality and to evaluate the influence of multivisceral resections on patient outcome. Methods This is a retrospective analysis of 94 patients undergoing resection of adenocarcinoma located in the pancreatic body and/or tail between April 1995 and December 2016 at our institution. Uni- and multivariable Cox regression analysis was conducted to identify independent prognostic factors for postoperative survival. Results Multivisceral resections, including partial resections of the liver, the large and small intestines, the stomach, the left kidney and adrenal gland, and major vessels, were carried out in 47 patients (50.0%). The median postoperative follow-up time was 12.90 (0.16–220.92) months. Median Kaplan-Meier survival after resection was 12.78 months with 1-, 3-, and 5-year survival rates of 53.2%, 15.8%, and 9.0%. Multivariable Cox regression identified coeliac trunk resection ( p = 0.027), portal vein resection ( p = 0.010), intraoperative blood transfusions ( p = 0.005), and lymph node ratio in percentage ( p = 0.001) as independent risk factors for survival. Although postoperative complications requiring surgical revision were observed more frequently after multivisceral resections (14.9 versus 2.1%; p = 0.029), postoperative survival was not significantly inferior when compared to patients undergoing standard distal or subtotal pancreatectomy (12.35 versus 13.87 months; p = 0.377). Conclusions Our data indicates that multivisceral resection in cases of locally advanced pancreatic carcinoma of the body and/or tail is justified, as it is not associated with increased mortality and can even facilitate long-term survival, albeit with an increase in postoperative morbidity. Simultaneous resections of major vessels, however, should be considered carefully, as they are associated with inferior survival.

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Section: Discussionsupporting

confidence: 86%

“…Data on the effect of such resections is scarce. Recently, Malinka et al and Panzeri et al each published results of single-center studies, indicating that multivisceral resections are justifiable in selected patients [ 10 , 11 ]. However, especially the role of vascular resections remains to be elusive.…”

Section: Introductionmentioning

confidence: 99%

Multivisceral resection for adenocarcinoma of the pancreatic body and tail—a retrospective single-center analysis

et al. 2020

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“…Likewise, De Reuver et al [11] found no difference in either perioperative morbidity (38% in SP vs. 35% in EP) or mortality (0% for both) in his study of 177 patients who underwent PD for ductal adenocarcinoma. Similar findings were also reported for patients who underwent DP with multivisceral resection by Seeliger et al [23] and Sahakyan et al [24], both of whom reported comparable morbidity but not mortality rates, and Panzeri et al [25], who reported comparable morbidity and mortality rates.…”

Section: Discussionsupporting

confidence: 75%

Short-Term Outcomes of Extended Pancreatectomy: A Single-Surgeon Experience

Low

Koh

Teo

et al. 2017

Gastrointest Tumors

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Background/Aims: The International Study Group of Pancreatic Surgery recently published a consensus statement on the definition of extended pancreatectomy (EP). We aimed to determine the safety profile and short-term outcomes of EP compared to standard pancreatectomy (SP). To mitigate surgeon bias, only pancreatectomies performed by a single surgeon were included. Methods: Ninety consecutive patients who underwent pancreatectomy by a single surgeon over a period of 5 years and who met our study criteria were classified into an SP or an EP group. Sixty-two patients underwent pancreaticoduodenectomy (PD), including total pancreatectomy, and 28 patients underwent distal pancreatectomy. Results: The 25 patients who underwent EP had significantly increased operation time, estimated blood loss, postoperative intensive care unit (ICU) transfer, and postoperative stay compared to the 65 patients who underwent SP. There was 1 (1.1%) 30-day mortality and 4 (4.4%) in-hospital mortalities. Postoperative morbidity and mortality were similar between both groups. Subgroup analysis of the patients who underwent PD demonstrated that the EP group (n = 22) had significantly increased operation time and postoperative ICU transfers. Conclusion: Although patients who underwent EP experienced significantly increased operative time, blood loss, and postoperative stay, they did not experience significantly higher postoperative morbidity or mortality compared to patients who underwent SP.

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“…Nevertheless, data are still lacking to confirm the value of vascular reconstruction in the presence of SMA or CA invasion. Multivisceral resection in the presence of nearby organ invasion is associated with a poorer survival when compared with standard resection [66][67][68][69] . These findings indicate a more aggressive behaviour of PanNETs when invading other organs.…”

Section: Which Is the Role Of Surgery For Borderline Resectable Or Lomentioning

confidence: 99%

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumours: Surgery for Small Intestinal and Pancreatic Neuroendocrine Tumours

Partelli

Bartsch²,

Capdevila³

et al. 2017

Neuroendocrinology

255

260

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The small intestine and pancreas are among the most frequent abdominal sites of origin of neuroendocrine tumours. Distinctive features of these forms are represented by the relatively low incidence and the wide heterogeneity in biological behaviour. In this light, it is difficult to standardize indications for surgery and the most appropriate approach. It would be helpful for surgeons managing patients with these tumours to have guidelines for surgical treatment of small intestinal neuroendocrine tumours and pancreatic neuroendocrine tumours. The proposed guidelines represent a consensus of the working group of the European Neuroendocrine Tumor Society (ENETS).

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Distal pancreatectomy associated with multivisceral resection: results from a single centre experience

Abstract: Multivisceral resection for cancer of body and tail of the pancreas is feasible in selected cases, with an acceptable surgical complication rate compared to standard procedures and a favorable long-term survival in ductal cancer.

Cited by 25 publications

References 32 publications

Multivisceral resection for adenocarcinoma of the pancreatic body and tail—a retrospective single-center analysis

Multivisceral resection for adenocarcinoma of the pancreatic body and tail—a retrospective single-center analysis

Short-Term Outcomes of Extended Pancreatectomy: A Single-Surgeon Experience

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumours: Surgery for Small Intestinal and Pancreatic Neuroendocrine Tumours

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