Multivisceral resection for pancreatic malignancies: risk-analysis and long-term outcome.
OBJECTIVE
To evaluate the safety and outcome of multivisceral pancreatic resections for primary pancreatic malignancies.


BACKGROUND
Curative resection is the only potential cure for patients with pancreatic cancer, but some patients present with advanced tumors that are not resectable by a standard pancreatic resection. Data on risk and survival analysis of extended pancreatic resections is limited.


METHODS
One hundred one patients who had a multivisceral pancreatic resection between 10/2001 and 12/2007 were identified from a prospective database, and perioperative and long-term results were compared with those of 202 matched patients with a standard pancreatic resection. Uni- and multivariate regression analysis were performed to identify parameters that are associated with perioperative morbidity. Long-term survival was evaluated.


RESULTS
Colon, stomach, adrenal gland, liver, hepatic or celiac artery, kidney, or small intestine were resected in 37.6%, 33.7%, 27.7%, 18.8%, 16.8%, 11.9%, and 6.9% of the 101 patients with multivisceral resection, respectively. Additional portal vein resection was performed in 20.8% of patients. Overall and surgical morbidity but not mortality was significantly increased compared with standard pancreatic resections (55.5% vs. 42.8%, 37.6 vs. 25.3%, and 3.0% vs. 1.5%, respectively). Uni- and multivariate analysis identified a long operative time and the extended multivisceral resection of 2 or more additional organs as independent risk factors for intraabdominal complications or need for relaparotomy. Median survival was comparable to that of standard pancreatic resections.


CONCLUSIONS
Multivisceral resections can be performed with increased morbidity but comparable mortality and long-term prognosis as compared with standard pancreatic resections at high volume centers. Increased morbidity is related to extended multivisceral resections with a long operative time.
Hartwig
Werner
W
Department of General Surgery, University of Heidelberg, Heidelberg 69120, Germany.
Hackert
Thilo
T
Hinz
Ulf
U
Hassenpflug
Matthias
M
Strobel
Oliver
O
Büchler
Markus W
MW
Werner
Jens
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000401:mortality / Q000706:statistics & numerical data*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014781:Viscera / Q000473:pathology / Q000601:surgery*; D055815:Young Adult