title: Additional organ resection combined with pancreaticoduodenectomy does not increase postoperative morbidity and mortality.
abstract: BACKGROUND
  The mortality associated with pancreaticoduodenectomy (PD) has decreased substantially in recent times, but high morbidity continues to be a significant problem. With reductions in mortality, there is increasing willingness to combine organ resections with PD when indicated. There is, however, a paucity of information regarding the morbidity and mortality of multivisceral resection (MVR) that involves pancreaticoduodenectomy (MVR-PD).
  
  
  METHODS
  Patients undergoing PD between January 2002 and November 2007 by a single surgeon were reviewed and perioperative outcomes determined. Those treated by PD alone were compared to those undergoing MVR-PD.
  
  
  RESULTS
  There were 105 patients overall who underwent PD during the study period, with MVR-PD performed in 19 patients. Twelve (63%) patients required PD combined with right colectomy, two (11%) underwent PD combined with right nephrectomy, two (11%) required liver resection with PD, and the remaining three (16%) had various combinations of kidney, colon, adrenal and small bowel resection in addition to PD. In both groups, the main indication for surgery was pancreatic cancer; however, there were proportionally more patients in the MVR-PD group with gastrointestinal stromal tumors (two (11%) patients), sarcomas (two (11%) patients) and metastases to the periampullary region (three (16%) patients). The overall complication rate in this study was 60%. Delayed gastric emptying (39%) and pancreatic fistula (16%) were the most common complications. There was no significant difference in complications between the two groups. A non pylorus-preserving PD was more commonly performed in cases of MVR-PD (53% vs 28%; p = 0.007), operating times were longer (9.5 vs 8 h; p = 0.002), and surgical intensive care unit stay was greater (2 vs 1 days; p < 0.001). The overall median length of hospital stay (7 days) and readmission rate were similar between the groups.
  
  
  CONCLUSIONS
  MVR-PD can be performed without significant added morbidity compared to PD alone. The main indication for MVR-PD is locally advanced pancreatic cancer requiring PD combined with right hemicolectomy.
authors.affiliation: Section of Surgical Oncology, Department of Surgery, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, H070, 500 University Drive, P.O. Box 850, Hershey, PA 17033-0850, USA. mnikfarjam@yahoo.com.au
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Nikfarjam
authors.forename: Mandeep
authors.initials: M
authors.lastname: Sehmbey
authors.forename: Eric T
authors.initials: ET
authors.lastname: Kimchi
authors.forename: Niraj J
authors.initials: NJ
authors.lastname: Gusani
authors.forename: Serene
authors.initials: S
authors.lastname: Shereef
authors.forename: Diego M
authors.initials: DM
authors.lastname: Avella
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Staveley-O'Carroll
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004378:Duodenal Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014781:Viscera / Q000601:surgery*; D055815:Young Adult