title: Simultaneous resection of abdominal cancer and synchronous pancreaticoduodenal metastasis: indications and literature review.
abstract: OBJECTIVE
  This study was aimed to identify the potential indications for simultaneous resection of abdominal cancer and synchronous pancreaticoduodenal metastasis (SRAPM) and improve the efficacy of SRAPM.
  
  
  METHODS
  The data of 34 patients who underwent SRAPM were retrospectively reviewed. The intraoperative findings, morbidity and mortality, patterns of tumor invasion in the pancreas and duodenum, lymph node metastases, long-term outcomes and causes of death were evaluated.
  
  
  RESULTS
  Fourteen patients (41.2%) developed complications, and 2 died of pancreatic fistulas with abdominal bleeding. The in-hospital mortality was 5.9%. The overall 1-year, 2-year and 3-year survival rates were 52.9%, 32.3% and 21.8%, respectively. The survival rates depended on the primary tumor, the invasion pattern, the presence of metastatic lymph nodes at the paraaortic site and the presence of residual tumor. The follow-up outcomes revealed that the main causes of death were as follows: systemic metastasis (n = 7), peritoneal metastasis (n = 6) and intrahepatic metastasis (n = 6).
  
  
  CONCLUSIONS
  SRAPM is indicated for low-grade malignant tumors and in cases with direct invasion of the pancreaticoduodenum. The presence of metastatic lymph nodes at the paraaortic site, intrahepatic metastasis, micro-peritoneal metastasis, and distinct metastasis should be contraindications for the surgical procedure.
authors.affiliation: Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, China.
authors.forename: Jing Wang
authors.initials: JW
authors.lastname: Tan
authors.forename: Hong Dong
authors.initials: HD
authors.lastname: Wang
authors.forename: Ben Shun
authors.initials: BS
authors.lastname: Hu
authors.forename: Ke
authors.initials: K
authors.lastname: Chen
authors.forename: Hong Bin
authors.initials: HB
authors.lastname: Xu
authors.forename: Fei
authors.initials: F
authors.lastname: Chen
authors.forename: Yun Chang
authors.initials: YC
authors.lastname: Tan
authors.forename: Jia Hong
authors.initials: JH
authors.lastname: Dong
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000556:secondary* / Q000601:surgery*; D004067:Digestive System Neoplasms / Q000473:pathology* / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000556:secondary / Q000601:surgery; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D018365:Neoplasm, Residual; D010185:Pancreatic Fistula / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000556:secondary / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000209:etiology*; D015996:Survival Rate; D013997:Time Factors