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

Abstract

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.

Irreversible Electroporation Plus Anti-PD-1 Antibody versus Irreversible Electroporation Alone for Patients with Locally Advanced Pancreatic Cancer

“… 22 Additionally, relatively high rates of postoperative complications of extended surgery also prevented the treatment of surgery to some degree. 26 Considering the fact that progression of local disease, other than distant metastasis, contributed to most of the mortalities of LAPC patients, local destructive method is worthy of being tried. 27 As a non-thermal local destructive method, IRE induces apoptosis of tumor cells through causing irreversible permeabilization in cell membrane.…”

“…22 Additionally, relatively high rates of postoperative complications of extended surgery also prevented the treatment of surgery to some degree. 26 Considering the fact that progression of local disease, other than distant metastasis, contributed to most of the…”

Extended Distal Pancreatectomy for Cancer of the Body and Tail of the Pancreas: Analysis of Early and Late Results

“…In terms of relative risk, the above-mentioned authors [ 23 ] report an almost 6-fold increase in the risk of complications with concurrent colectomy in their univariate analysis, but not in their multivariable analysis. Beetz et al [ 26 ] showed that clinically-relevant pancreatic fistula was more frequent after extended distal pancreatectomy, but without statistical significance. Hartwig et al [ 8 ] found that extended DP was associated with a significant increase in overall and surgical morbidity but not mortality.…”

Survival Comparison of Neoadjuvant Chemotherapy Followed by Irreversible Electroporation Versus Conversional Resection for Locally Advanced Pancreatic Cancer

“…Extended surgery including vascular resection is often necessary in order to achieve tumor-free resection margins. A relatively high postoperative complications of extended surgery compared with standard pancreatectomy would also decrease survival to some degrees ( 14 ). Considering the tumor biology and the response to neoadjuvant chemotherapy, usually surgical resection was performed in patients whose CA19-9 levels decreased by more than a half after neoadjuvant chemotherapy ( 10 ).…”