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Distal pancreatectomy associated with multivisceral resection: results from a single centre experience

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Abstract

Purpose

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).

Conclusion

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.

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Acknowledgments

Authors’ contribution

Study conception and design: CB, GB, RS, FP, GMar, GMal—Acquisition of data: FP, GMar, AM, LM, TM—Analysis of data: FP, GMar, GMal—Drafting of manuscript: FP—Critical revision of manuscript: CB, GB, RS, GMar, GMal.

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Authors and Affiliations

  1. Department of General Surgery, Ospedale “Mater Salutis”, Legnago, VR, Italy

    Francesca Panzeri

  2. Pancreas Institute, University of Verona, P.le L.A. Scuro 10, 37134, Verona, VR, Italy

    Giovanni Marchegiani, Giuseppe Malleo, Anna Malpaga, Laura Maggino, Tiziana Marchese, Roberto Salvia & Claudio Bassi

  3. Pancreatic Surgery Department, Casa di Cura “Dott. Pederzoli”, Peschiera del Garda, VR, Italy

    Giovanni Butturini

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  1. Francesca Panzeri
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Correspondence to Claudio Bassi.

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All of the authors declare that they have no conflicts of interest. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards; this article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all individual participants included in the study.

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Panzeri, F., Marchegiani, G., Malleo, G. et al. Distal pancreatectomy associated with multivisceral resection: results from a single centre experience. Langenbecks Arch Surg 402, 457–464 (2017). https://doi.org/10.1007/s00423-016-1514-0

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