title: Multivisceral and extended resections during pancreatoduodenectomy increase morbidity and mortality.
abstract: BACKGROUND
  Improvements in outcomes after pancreatoduodenectomy (PD) have permitted more complex resections. Complete extirpation at PD may require multivisceral resection (MVR-PD); however, descriptions of morbidity of MVR-PD are limited to small, single-institution series.
  
  
  METHODS
  The National Surgical Quality Improvement Project database (2005-2011) was used to compare 30-day postoperative morbidity of PD with MVR-PD. Concurrent resection of colon, small bowel, stomach, kidney, or adrenal gland defined MVR-PD.
  
  
  RESULTS
  Of 9,927 PDs, MVR-PD was performed in 273 patients (3%). MVR included colon (58%), small bowel (30%), and gastric (12%) resections. Preoperative comorbidities were similar between groups. Pancreatic, duodenal, or periampullary cancer was present in 75% of patients. Mortality (8.8% vs 2.9%) and major morbidity (56.8% vs 30.8%) were much greater for MVR-PD versus PD alone (P < .001). MVR-PD patients also experienced greater rates of wound, pulmonary, cardiac, thromboembolic, renal, and septic complications. On multivariable regression, MVR was an independent predictor of death (odds ratio [OR], 3.4; P < .001), overall morbidity (OR, 3.01; P < .001), major morbidity (OR, 3.21; P < .001), and minor morbidity (OR, 1.65; P = .03). Among patients undergoing PD+MVR, colectomy was an independent predictor of increased overall morbidity (OR, 1.96; P = .03) and major morbidity (OR, 1.90; P = .02).
  
  
  CONCLUSIONS
  Margin-negative resection may require MVRs at the time of PD. MVR at is associated with 3-fold mortality and substantial morbidity after adjusting for comorbidities. Colectomy independently predicted major morbidity. At PD, the morbidity of MVR should be approached with caution when attempting margin-negative resection.
authors: Program for Liver, Pancreas, and Foregut Tumors, Department of Surgery, College of Medicine, Penn State Cancer Institute, Pennsylvania State University, Hershey, PA.
authors: Neil H
authors: NH
authors: Bhayani
authors: Program for Liver, Pancreas, and Foregut Tumors, Department of Surgery, College of Medicine, Penn State Cancer Institute, Pennsylvania State University, Hershey, PA.
authors: Laura M
authors: LM
authors: Enomoto
authors: Program for Liver, Pancreas, and Foregut Tumors, Department of Surgery, College of Medicine, Penn State Cancer Institute, Pennsylvania State University, Hershey, PA.
authors: Ben C
authors: BC
authors: James
authors: Program for Liver, Pancreas, and Foregut Tumors, Department of Surgery, College of Medicine, Penn State Cancer Institute, Pennsylvania State University, Hershey, PA.
authors: Gail
authors: G
authors: Ortenzi
authors: Program for Liver, Pancreas, and Foregut Tumors, Department of Surgery, College of Medicine, Penn State Cancer Institute, Pennsylvania State University, Hershey, PA.
authors: Jussuf T
authors: JT
authors: Kaifi
authors: Program for Liver, Pancreas, and Foregut Tumors, Department of Surgery, College of Medicine, Penn State Cancer Institute, Pennsylvania State University, Hershey, PA.
authors: Eric T
authors: ET
authors: Kimchi
authors: Program for Liver, Pancreas, and Foregut Tumors, Department of Surgery, College of Medicine, Penn State Cancer Institute, Pennsylvania State University, Hershey, PA.
authors: Kevin F
authors: KF
authors: Staveley-O'Carroll
authors: Program for Liver, Pancreas, and Foregut Tumors, Department of Surgery, College of Medicine, Penn State Cancer Institute, Pennsylvania State University, Hershey, PA. Electronic address: ngusani@psu.edu.
authors: Niraj J
authors: NJ
authors: Gusani
mesh_terms: D000315:Adrenalectomy / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000401:mortality; D016208:Databases, Factual; D004379:Duodenal Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000401:mortality; D006801:Humans; D007421:Intestine, Small / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000401:mortality; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D016896:Treatment Outcome; D014481:United States