Safety and outcome of combined liver and pancreatic resections

Abstract

Background: In Western countries, combined liver and pancreatic resections (CLPR) are performed rarely because of the perceived high morbidity and mortality rates. This study evaluated the safety and outcomes of CLPR at a tertiary European centre for hepatopancreatobiliary surgery.Methods: A review of two prospectively maintained databases for pancreatic and liver resections was undertaken to identify patients undergoing CLPR between January 1994 and January 2012. Clinicopathological and surgical outcomes were analysed. Univariable and multivariable analyses for postoperative morbidity were performed.Results: Fifty consecutive patients with a median age of 58 (range 20-81) years underwent CLPR. Indications for surgery were neuroendocrine carcinoma (16 patients), biliary cancer (15), colonic cancer (5), duodenal cancer (1) and others (13). The type of pancreatic resection included pancreaticoduodenectomy (30), distal pancreatectomy (17), spleen-preserving distal pancreatectomy (2) and total pancreatectomy (1). Twenty-three patients had associated major hepatectomies, 27 underwent minor liver resections and 11 had associated vascular resections. Mortality and morbidity rates were 4 and 46 per cent respectively. Univariable and multivariable analysis showed no differences in postoperative morbidity in relation to extent of liver resection or type of pancreatic resection. Use of preoperative chemotherapy was the only independent risk factor associated with postoperative morbidity (P = 0·021).Conclusion: CLPR can be performed with fairly low morbidity and mortality rates. Postoperative outcomes were not affected by the extent of liver resection or the type of pancreatic resection. Patients receiving chemotherapy should be evaluated carefully before surgery is considered.

New criterion for borderline resectable pancreatic cancer: Invasion of a replaced right hepatic artery

“…To the best of our knowledge, the above reported patient is the first one in the literature with a combined PD and right hemi-hepatectomy for a PA invasive into the rRHA. The feasibility and safety of the combined pancreatectomy and hepatectomy has been previously demonstrated (36), but there is a limited number of patients reported in the literature (36,37). Simultaneous liver resection and PD for oncologic HPB diseases is a procedure that is rarely performed, with only 1% of HBP cases in the USA, less than 400 cases reported from Asia, and about 100 cases reported in Europe (37).…”

“…However, a recent study has shown that patients with synchronous PD and hemi-hepatectomy may have very high morbidity and in-hospital mortality rates (87.5% and 18.2%, respectively) (37). Nevertheless, the morbidity and mortality rates after combined pancreatectomies and hepatectomies appear to be lower, compared with pancreatectomies with arterial resection and reconstruction (mortality 0-18.2% vs. 0-45.5%; morbidity 3-87.5% vs. 16.7 -100%) (11,36,37). This latter data, in addition to liver volumetry, were taken into consideration in the above presented patient, when a right hemi-hepatectomy was considered instead of an arterial reconstruction.…”

Onco-surgical Strategies in Pancreatic Ductal Adenocarcinoma

“…The feasibility and safety of combined pancreatectomies and liver resections has been already demonstrated (95). Actually most patients resected for M1 liver PDAC reported in the literature underwent wedge/atypical only liver resections (96)(97)(98).…”

Multivisceral Resection in Patients with Advanced Abdominal Tumors

“…Because the surgical procedures and diagnoses vary, the literature on the subject is rare. Most publications on multivisceral resections are limited to specific diagnosis, and few focus on different malignant diagnoses (5–7).…”