title: Hepato-pancreatectomy: how morbid? Results from the national surgical quality improvement project.
abstract: BACKGROUND
  Simultaneous resection of both the liver and the pancreas carries significant complexity. The objective of this study was to investigate peri-operative outcomes after a synchronous hepatectomy and pancreatectomy (SHP).
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Project database was queried to identify patients who underwent SHP. Resections were categorized as '< hemihepatectomy', '≥ hemihepatectomy' (hemihepatectomy and trisectionectomy), 'PD' (pancreaticoduodenectomy and total pancreatectomy) and 'distal' (distal pancreatectomy and enucleation).
  
  
  RESULTS
  From 2005 to 2013, 480 patients underwent SHP. Patients were stratified based on the extent of resection: '< hemihepatectomy + distal (n = 224)', '≥ hemihepatectomy + distal' (n = 49), '< hemihepatectomy + PD' (n = 83) and '≥ hemihepatectomy + PD' (n = 24). Although the first three groups had a reasonable and comparable safety profile (morbidity 33-51% and mortality 0-6.6%), the '≥ hemihepatectomy + PD' group was associated with an 87.5% morbidity (organ space infection 58.3%, re-intubation 12.5%, reoperation 25% and septic shock 25%), 8.3% 30-day mortality and 18.2% in-hospital mortality.
  
  
  CONCLUSIONS
  A synchronous hemihepatectomy (or trisectionectomy) with PD remains a highly morbid combination and should be reserved for patients who have undergone extremely cautious selection.
authors.affiliation: Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.
authors.forename: Thuy B
authors.initials: TB
authors.lastname: Tran
authors.affiliation: Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.
authors.forename: Monica M
authors.initials: MM
authors.lastname: Dua
authors.affiliation: Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Spain
authors.affiliation: Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.
authors.forename: Brendan C
authors.initials: BC
authors.lastname: Visser
authors.affiliation: Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Norton
authors.affiliation: Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.
authors.forename: George A
authors.initials: GA
authors.lastname: Poultsides
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006498:Hepatectomy / Q000592:standards*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010180:Pancreatectomy / Q000592:standards*; D010182:Pancreatic Diseases / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D058996:Quality Improvement; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult