title: [Pancreatoduodenectomy for suspected malignancy: indications, complications and survival].
abstract: OBJECTIVE
  To evaluate the indications, complications and survival after pancreatoduodenectomy, with special attention for the outcome after extended resection due to tumour extension and in elderly patients.
  
  
  METHODS
  Retrospective, partly cross-sectional study.
  
  
  METHODS
  All 275 consecutive adult patients who underwent explorative laparotomy for a suspected resectable pancreatic head tumour or periampulary tumour in two Dutch tertiary centres between 2007 and 2010 were included. We graded the postoperative complications according to international classifications and collected data on survival.
  
  
  RESULTS
  In 218/275 patients (79%) the tumour could be resected by pancreatoduodenectomy with or without an extended resection. Malignancy was confirmed in 190/218 patients (87%); in 153/190 patients (81%) a microscopically radical (R0) resection was achieved. Fifteen percent of the patients required a re-intervention (radiological, endoscopic or surgical) because of an intra-abdominal complication. The post-operative 30-day mortality was 4.1%. Eighty-six patients (39%) were ultimately diagnosed with 'pancreatic adenocarcinoma'; they had a 1- and 2-year survival rate of 63% and 34%, respectively. In 27 patients (12%) who underwent an extended resection for oncological reasons, such as partial hepatic portal vein resection, the 30-day mortality was 0% and the survival rates were comparable to patients with a standard resection. The 81 patients (37%) aged 70 or older had a 30-day mortality and survival similar to younger patients.
  
  
  CONCLUSIONS
  More than 75% of potentially resectable tumours were resected by a pancreatoduodenectomy with or without an extended resection, with a relatively low postoperative mortality and an adequate survival benefit. After multidisciplinary assessment, both limited tumour extension and a higher age are not necessarily contraindications for a resection, as a comparable survival benefit can be obtained for these groups of patients as for other groups.
authors.affiliation: Universitair Medisch Centrum Utrecht, Afd. Heelkunde, Utrecht, the Netherlands.
authors.forename: Kasia P
authors.initials: KP
authors.lastname: Cieslak
authors.forename: Marc G H
authors.initials: MG
authors.lastname: Besselink
authors.forename: Anton P
authors.initials: AP
authors.lastname: Rijkers
authors.forename: Maarten  S
authors.initials: M
authors.lastname: van Leeuwen
authors.forename: Frank P
authors.initials: FP
authors.lastname: Vleggaar
authors.forename: Marco
authors.initials: M
authors.lastname: Bruno
authors.forename: Katharina
authors.initials: K
authors.lastname: Biermann
authors.forename: Inne H M
authors.initials: IH
authors.lastname: Borel Rinkes
authors.forename: Casper H
authors.initials: CH
authors.lastname: van Eijck
authors.forename: I Quintus
authors.initials: IQ
authors.lastname: Molenaar
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate