Outcomes after extended pancreatectomy in patients with borderline resectable and locally advanced pancreatic cancer.
BACKGROUND
In the recent International Study Group of Pancreatic Surgery (ISGPS) consensus on extended pancreatectomy, several issues on perioperative outcome and long-term survival remained unclear. Robust data on outcomes are sparse. The present study aimed to assess the outcome of extended pancreatectomy for borderline resectable and locally advanced pancreatic cancer.


METHODS
A consecutive series of patients with primary pancreatic adenocarcinoma undergoing extended pancreatectomies, as defined by the new ISGPS consensus, were compared with patients who had a standard pancreatectomy. Univariable and multivariable analysis was performed to identify risk factors for perioperative mortality and characteristics associated with survival. Long-term outcome was assessed by means of Kaplan-Meier analysis.


RESULTS
The 611 patients who had an extended pancreatectomy had significantly greater surgical morbidity than the 1217 patients who underwent a standard resection (42·7 versus 34·2 per cent respectively), and higher 30-day mortality (4·3 versus 1·8 per cent) and in-hospital mortality (7·5 versus 3·6 per cent) rates. Operating time of 300 min or more, extended total pancreatectomy, and ASA fitness grade of III or IV were associated with increased in-hospital mortality in multivariable analysis, whereas resections involving the colon, portal vein or arteries were not. Median survival and 5-year overall survival rate were reduced in patients having extended pancreatectomy compared with those undergoing a standard resection (16·1 versus 23·6 months, and 11·3 versus 20·6 per cent, respectively). Older age, G3/4 tumours, two or more positive lymph nodes, macroscopic positive resection margins, duration of surgery of 420 min or above, and blood loss of 1000 ml or more were independently associated with decreased overall survival.


CONCLUSIONS
Extended resections are associated with increased perioperative morbidity and mortality, particularly when extended total pancreatectomy is performed. Favourable long-term outcome is achieved in some patients.
Departments of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.|Departments of General, Visceral and Transplantation Surgery, University of Munich, Munich, Germany.
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W
Hartwig
Departments of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.|Departments of General, Visceral and Transplantation Surgery, University of Munich, Munich, Germany.
A
A
Gluth
Departments of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
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U
Hinz
Departments of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.|Departments of General, Visceral and Transplantation Surgery, University of Munich, Munich, Germany.
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D
Koliogiannis
Departments of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
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O
Strobel
Departments of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
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T
Hackert
Departments of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.|Departments of General, Visceral and Transplantation Surgery, University of Munich, Munich, Germany.
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J
Werner
Departments of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany. markus.buechler@med.uni-heidelberg.de.
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Büchler
D000368:Aged; D016063:Blood Loss, Surgical; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000601:surgery*; D005260:Female; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods / Q000401:mortality; D061646:Operative Time; D010180:Pancreatectomy / Q000379:methods* / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome