title: Distal pancreatectomy associated with multivisceral resection: results from a single centre experience.
abstract: OBJECTIVE
  Tumors arising in the body/tail of the pancreas tend to be diagnosed at a more advanced stage, with a lower rate of resectability compared to disease of the head. Distal pancreatectomy (DP) associated to multivisceral resections (MVR) can represent a surgical option for selected patients with advanced tumors.
  
  
  METHODS
  We retrospectively analyzed data of patients who underwent DP associated with MVR at our Institution over a 9-year period, and compared them to standard DP. MVR was defined as resection of at least one additional organ or vascular structure because of neoplastic involvement.
  
  
  RESULTS
  Out of 508 DP, in 59 cases MVR was performed. The absolute incidence of complications was comparable between the two groups (69.5 % in MVR arm vs. 57.2 % in control arm, p = 0.072) but more patients in the study group had a Clavien-Dindo class ≥3 (18.6 vs. 9.8 %, p = 0.04). A longer operative time (291 ± 91 vs. 227 ± 67, p < 0.001), an increased need for intraoperative transfusions (21.4 vs. 3.3 %, p < 0.001) and a slightly longer hospitalization (9 [7-16] days vs. 8 [7-10]; p < 0.001) were observed in the MVR group. In patients with ductal adenocarcinoma (n = 118), mortality was comparable between groups (p = 0.44) over a median follow up of 26 [16-41] months. In contrast, among patients with neuroendocrine neoplasms, mortality was higher in the study group (p = 0.002).
  
  
  CONCLUSIONS
  Multivisceral resection for cancer of body and tail of the pancreas is feasible in selected cases, with an acceptable surgical complication rate compared to standard procedures and a favorable long-term survival in ductal cancer.
authors: Department of General Surgery, Ospedale "Mater Salutis", Legnago, VR, Italy.
authors: Francesca
authors: F
authors: Panzeri
authors: Pancreas Institute, University of Verona, P.le L.A. Scuro 10, 37134, Verona, VR, Italy.
authors: Giovanni
authors: G
authors: Marchegiani
authors: Pancreas Institute, University of Verona, P.le L.A. Scuro 10, 37134, Verona, VR, Italy.
authors: Giuseppe
authors: G
authors: Malleo
authors: Pancreas Institute, University of Verona, P.le L.A. Scuro 10, 37134, Verona, VR, Italy.
authors: Anna
authors: A
authors: Malpaga
authors: Pancreas Institute, University of Verona, P.le L.A. Scuro 10, 37134, Verona, VR, Italy.
authors: Laura
authors: L
authors: Maggino
authors: Pancreas Institute, University of Verona, P.le L.A. Scuro 10, 37134, Verona, VR, Italy.
authors: Tiziana
authors: T
authors: Marchese
authors: Pancreas Institute, University of Verona, P.le L.A. Scuro 10, 37134, Verona, VR, Italy.
authors: Roberto
authors: R
authors: Salvia
authors: Pancreas Institute, University of Verona, P.le L.A. Scuro 10, 37134, Verona, VR, Italy. claudio.bassi@univr.it.
authors: Claudio
authors: C
authors: Bassi
authors: Pancreatic Surgery Department, Casa di Cura "Dott. Pederzoli", Peschiera del Garda, VR, Italy.
authors: Giovanni
authors: G
authors: Butturini
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000601:surgery*; D061646:Operative Time; D010180:Pancreatectomy / Q000009:adverse effects*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014781:Viscera / Q000473:pathology / Q000601:surgery*
keywords: Distal pancreatectomy; Multivisceral resection; Pancreatic cancer; Pancreatic fistula