title: Combined pancreaticoduodenectomy and colon resection for locally advanced peri-ampullary tumours: analysis of peri-operative morbidity and mortality.
abstract: BACKGROUND
  Combined pancreaticoduodenectomy (PD) and colonic resection may be necessary to achieve an R0 resection of peri-ampullary tumours. The aim of this study was to examine the morbidity and mortality associated with this procedure.
  
  
  METHODS
  A retrospective cohort study was performed comparing 607 patients who underwent a standard pancreaticoduodenectomy (S-PD) to 28 patients who had a concomitant colon resection and PD (PD-colon) over a 10-year period at an academic centre.
  
  
  RESULTS
  Patients in the PD-colon group were more likely to have received neoadjuvant chemotherapy ± radiation (3/28, 11% versus 14/607, 2%, P = 0.024). Operative time was also longer (530 versus 410 min, P < 0.001) and they were more likely to have had portal vein resections (9/28, 32% versus 76/607, 13%, P = 0.007). There was no difference in the intra-operative blood loss, length of stay, or overall complication rates. The PD-colon group had a higher rate of severe post-operative bleeding (4/28, 11% versus 8/607, 1%, P = 0.002). The post-operative mortality rates for the PD-colon and PD groups were 2/28 (7%) and 8/607 (1%), respectively (P = 0.068).
  
  
  CONCLUSIONS
  PD-colon has an acceptable risk of peri-operative morbidity compared with S-PD in well-selected patients.
authors.affiliation: Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Temple
authors.forename: Peter T W
authors.initials: PT
authors.lastname: Kim
authors.forename: Pablo E
authors.initials: PE
authors.lastname: Serrano
authors.forename: Daniel
authors.initials: D
authors.lastname: Kagedan
authors.forename: Sean P
authors.initials: SP
authors.lastname: Cleary
authors.forename: Carol-Anne
authors.initials: CA
authors.lastname: Moulton
authors.forename: Ian D
authors.initials: ID
authors.lastname: McGilvray
authors.forename: Steven
authors.initials: S
authors.lastname: Gallinger
authors.forename: Paul D
authors.initials: PD
authors.lastname: Greig
authors.forename: Alice C
authors.initials: AC
authors.lastname: Wei
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D017024:Chemotherapy, Adjuvant; D003082:Colectomy / Q000009:adverse effects* / Q000401:mortality*; D004067:Digestive System Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009864:Ontario; D061646:Operative Time; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
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