Abstract
Complex multivisceral resections in major hepatic and pancreatic surgery are relatively infrequent, and information regarding the morbidity and mortality associated with such resections is scant. The purpose of this paper is to describe the outcomes following such aggressive surgical treatment. A retrospective review of the outcomes following multiorgan resection in the setting of major liver or pancreatic resection was conducted from 2002 until July 2006. Patients who had a major hepatic or pancreatic resection plus resection of at least one other organ were included. The primary outcome measures analyzed were the postoperative morbidity and mortality. Secondary outcomes included recurrence rates and survival. Twenty-seven patients met the inclusion criteria. There were two postoperative deaths (7%). Complications occurred in 59% of patients. Complications were minor in 26% and severe in 33%. Complications were more frequent in older patients and in patients with pancreatic resections. Mortality was significantly increased in the setting of a pancreaticoduodenectomy. These more aggressive procedures should be considered to carry a higher risk of complications, particularly in patients undergoing pancreaticoduodenectomies. Patients should be selected carefully when undertaking complex multivisceral resections in major hepatic and pancreatic surgery.
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Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, Sydes M, Fayers P. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer 1999;79:1522–1530.
Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, van EP, Obertop H, Gouma DJ, Taat CW. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 1995;345:745–748.
Ries LA, Eisner MP, Kosary CL, Hankey BF, Miller BA, Clegg L et al. SEER Cancer Statistics Review, 1975–2002. Bethesda, MD: National Cancer Institute, 2004.
Mella J, Biffin A, Radcliffe AG, Stamatakis JD, Steele RJ. Population-based audit of colorectal cancer management in two UK health regions. Colorectal Cancer Working Group, Royal College of Surgeons of England Clinical Epidemiology and Audit Unit. Br J Surg 1997;84:1731–1736.
Schwarz RE. Visceral organ resections combined with synchronous major hepatectomy: examples of safety and feasibility. HPB 2003;5:27–32.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–213.
Nagino M, Kamiya J, Nishio H, Ebata T, Arai T, Nimura Y. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg 2006;243:364–372.
D’Angelica M, Martin RC, Jarnagin WR, Fong Y, DeMatteo RP, Blumgart LH. Major hepatectomy with simultaneous pancreatectomy for advanced hepatobiliary cancer. J Am Coll Surg 2004;198:570–576.
Sasson AR, Hoffman JP, Ross EA, Kagan SA, Pingpank JF, Eisenberg BL. En bloc resection for locally advanced cancer of the pancreas: is it worthwhile? J Gastrointest Surg 2002;6:147–157.
Martin RC, Jaques DP, Brennan MF, Karpeh M. Achieving RO resection for locally advanced gastric cancer: is it worth the risk of multiorgan resection? J Am Coll Surg 2002;194:568–577.
Carboni F, Lepiane P, Santoro R, Lorusso R, Mancini P, Sperduti I, Carlini M, Santoro E. Extended multiorgan resection for T4 gastric carcinoma: 25-year experience. J Surg Oncol 2005;90:95–100.
Piso P, Bellin T, Aselmann H, Bektas H, Schlitt HJ, Klempnauer J. Results of combined gastrectomy and pancreatic resection in patients with advanced primary gastric carcinoma. Dig Surg 2002;19:281–285.
Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, Cook P. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet 1996;347:995–999.
Weber JC, Bachellier P, Oussoultzoglou E, Jaeck D. Simultaneous resection of colorectal primary tumour and synchronous liver metastases. Br J Surg 2003;90:956–962.
de SE, Lassalle FB, McCormack L, Pekolj J, Quintana GO, Vaccaro C, Benati M. Simultaneous colorectal and hepatic resections for colorectal cancer: postoperative and longterm outcomes. J Am Coll Surg 2002;195:196–202.
Chua HK, Sondenaa K, Tsiotos GG, Larson DR, Wolff BG, Nagorney DM. Concurrent vs. staged colectomy and hepatectomy for primary colorectal cancer with synchronous hepatic metastases. Dis Colon Rectum 2004;47:1310–1316.
Martin R, Paty P, Fong Y, Grace A, Cohen A, DeMatteo R, Jarnagin W, Blumgart L. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg 2003;197:233–241.
Capussotti L, Ferrero A, Vigano L, Ribero D, Lo TR, Polastri R. Major liver resections synchronous with colorectal surgery. Ann Surg Oncol 2007;14:195–201.
Karoui M, Penna C, min-Hashem M, Mitry E, Benoist S, Franc B, Rougier P, Nordlinger B. Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg 2006;243:1–7.
Tanaka K, Shimada H, Matsuo K, Nagano Y, Endo I, Sekido H, Togo S. Outcome after simultaneous colorectal and hepatic resection for colorectal cancer with synchronous metastases. Surgery 2004;136:650–659.
Fujita S, Akasu T, Moriya Y. Resection of synchronous liver metastases from colorectal cancer. Jpn J Clin Oncol 2000;30:7–11.
Capussotti L, Vigano’ L, Ferrero A, Lo TR, Ribero D, Polastri R. Timing of resection of liver metastases synchronous to colorectal tumor: proposal of prognosis-based decisional model. Ann Surg Oncol 2007;14:1143–1150.
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This material was presented as a poster at the American Hepato-Pancreato-Biliary Association 2007 Annual Meeting in Las Vegas, Nevada—April 19 to April 22, 2007.
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McKay, A., Sutherland, F.R., Bathe, O.F. et al. Morbidity and Mortality Following Multivisceral Resections in Complex Hepatic and Pancreatic Surgery. J Gastrointest Surg 12, 86–90 (2008). https://doi.org/10.1007/s11605-007-0273-1
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DOI: https://doi.org/10.1007/s11605-007-0273-1