title: Reoperative completion pancreatectomy for suspected malignant disease of the pancreas.
abstract: BACKGROUND
  Completion pancreatectomy (CP) is a reoperative procedure to excise remnant pancreatic tissue after a prior pancreatic resection. In this study, we document our institution's experience with CP for recurrent malignant disease of the pancreas, describing indications for surgery, procedures performed, and patient outcomes.
  
  
  METHODS
  We performed a retrospective review of 861 patients from the pancreatic surgery database in the Department of Surgery of Thomas Jefferson University from October 2005 to December 2010 to identify all cases of CP performed for suspected malignant disease.
  
  
  RESULTS
  Eleven patients underwent reoperative CP at our institution from 2005 to 2010. The median time interval between the initial operation and CP was 32 mo. A combination of clinical symptoms, elevated tumor markers, and imaging studies were used for diagnosis of recurrent disease. Pancreatic ductal adenocarcinoma was the most common pathology, found in six patients. The postoperative complication rate was 18% and the median postoperative hospital length of stay was 6 d. There were no 30-d readmissions and no perioperative deaths. The 1-y survival rate following CP was 71% with an overall median survival of 17.5 mo.
  
  
  CONCLUSIONS
  CP is a safe and effective option for a highly selected group of patients with suspected recurrent malignant disease of the remnant pancreas. Morbidity and mortality rates are within acceptable limits and similar to initial pancreatic resection. Eligibility depends heavily upon the absence of distant metastatic disease, technical factors for resection, and patient performance status.
authors.affiliation: Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary, and Related Cancer Center, Philadelphia, Pennsylvania 19107, USA. harish.lavu@jefferson.edu
authors.forename: Harish
authors.initials: H
authors.lastname: Lavu
authors.forename: Leonard J
authors.initials: LJ
authors.lastname: Nowcid
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Klinge
authors.forename: Krishnaraj
authors.initials: K
authors.lastname: Mahendraraj
authors.forename: Dane R
authors.initials: DR
authors.lastname: Grenda
authors.forename: Patricia K
authors.initials: PK
authors.lastname: Sauter
authors.forename: Ernest L
authors.initials: EL
authors.lastname: Rosato
authors.forename: Eugene P
authors.initials: EP
authors.lastname: Kennedy
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Yeo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies