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Additional Organ Resection Combined with Pancreaticoduodenectomy does not Increase Postoperative Morbidity and Mortality

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Journal of Gastrointestinal Surgery



The mortality associated with pancreaticoduodenectomy (PD) has decreased substantially in recent times, but high morbidity continues to be a significant problem. With reductions in mortality, there is increasing willingness to combine organ resections with PD when indicated. There is, however, a paucity of information regarding the morbidity and mortality of multivisceral resection (MVR) that involves pancreaticoduodenectomy (MVR-PD).


Patients undergoing PD between January 2002 and November 2007 by a single surgeon were reviewed and perioperative outcomes determined. Those treated by PD alone were compared to those undergoing MVR-PD.


There were 105 patients overall who underwent PD during the study period, with MVR-PD performed in 19 patients. Twelve (63%) patients required PD combined with right colectomy, two (11%) underwent PD combined with right nephrectomy, two (11%) required liver resection with PD, and the remaining three (16%) had various combinations of kidney, colon, adrenal and small bowel resection in addition to PD. In both groups, the main indication for surgery was pancreatic cancer; however, there were proportionally more patients in the MVR-PD group with gastrointestinal stromal tumors (two (11%) patients), sarcomas (two (11%) patients) and metastases to the periampullary region (three (16%) patients). The overall complication rate in this study was 60%. Delayed gastric emptying (39%) and pancreatic fistula (16%) were the most common complications. There was no significant difference in complications between the two groups. A non pylorus-preserving PD was more commonly performed in cases of MVR-PD (53% vs 28%; p = 0.007), operating times were longer (9.5 vs 8 h; p = 0.002), and surgical intensive care unit stay was greater (2 vs 1 days; p < 0.001). The overall median length of hospital stay (7 days) and readmission rate were similar between the groups.


MVR-PD can be performed without significant added morbidity compared to PD alone. The main indication for MVR-PD is locally advanced pancreatic cancer requiring PD combined with right hemicolectomy.

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  1. Sauve L. Des pancréatectomies et spécialement de la pancréatectomie céphalique. Rev Chir 1908;37:113–152. and 335–385.

    Google Scholar 

  2. Whipple AO. Pancreaticoduodenectomy for islet carcinoma. Ann Surg 1945;121:847–852. doi:10.1097/00000658-194506000-0000.

    Article  PubMed  CAS  Google Scholar 

  3. Hunt VC. Surgical management of carcinoma of the ampulla of Vater and of the periampullary portion of the duodenum. Surg Gynecol Obstet (Paris) 1941;114:570–602.

    CAS  Google Scholar 

  4. Whipple AO. The rationale of radical surgery for cancer of the pancreas and ampullary region. Ann Surg 1941;114:612–615. doi:10.1097/00000658-194111440-00008.

    Article  PubMed  CAS  Google Scholar 

  5. Orr TG. Pancreaticoduodenectomy for carcinoma of the ampulla and ampullary region. Surgery 1945;18:144–158.

    Google Scholar 

  6. Whipple AO. Radical surgery for certain cases of pancreatic fibrosis associated with calcareous deposits. Ann Surg 1946;124:991–1008. doi:10.1097/00000658-194612000-00001.

    Article  PubMed  CAS  Google Scholar 

  7. Harvey SC, Oughterson AW. Carcinoma of the pancreas and ampullary region: report of six additional cases. Ann Surg 1942;115:1066–1090. doi:10.1097/00000658-194206000-00018.

    Article  PubMed  CAS  Google Scholar 

  8. Cameron JL, Pitt HA, Yeo CJ et al. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg 1993;217:430–435. discussion 435–438, doi:10.1097/00000658-199305010-00002.

    Article  PubMed  CAS  Google Scholar 

  9. Fernandez-del Castillo C, Rattner DW, Warshaw AL. Standards for pancreatic resection in the 1990s. Arch Surg 1995;130:295–299. discussion 299–300.

    PubMed  CAS  Google Scholar 

  10. Lieberman MD, Kilburn H, Lindsey M et al. Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg 1995;222:638–645. doi:10.1097/00000658-199511000-00006.

    Article  PubMed  CAS  Google Scholar 

  11. Pratt W, Joseph S, Callery MP et al. POSSUM accurately predicts morbidity for pancreatic resection. Surgery 2008;143:8–19. doi:10.1016/j.surg.2007.07.035.

    Article  PubMed  Google Scholar 

  12. Lowy AM, Lee JE, Pisters PW et al. Prospective, randomized trial of octreotide to prevent pancreatic fistula after pancreaticoduodenectomy for malignant disease. Ann Surg 1997;226:632–641. doi:10.1097/00000658-199711000-00008.

    Article  PubMed  CAS  Google Scholar 

  13. DeOliveira ML, Winter JM, Schafer M et al. Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 2006;244:931–937. discussion 937–939, doi:10.1097/01.sla.0000246856.03918.9a.

    Article  PubMed  Google Scholar 

  14. Grobmyer SR, Pieracci FM, Allen PJ et al. Defining morbidity after pancreaticoduodenectomy: use of a prospective complication grading system. J Am Coll Surg 2007;204:356–364. doi:10.1016/j.jamcollsurg.2006.11.017.

    Article  PubMed  Google Scholar 

  15. Balcom JHt, Rattner DW, Warshaw AL et al. Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg 2001;136:391–398. doi:10.1001/archsurg.136.4.391.

    Article  PubMed  Google Scholar 

  16. D’Angelica M, Martin RC 2nd, Jarnagin WR et al. Major hepatectomy with simultaneous pancreatectomy for advanced hepatobiliary cancer. J Am Coll Surg 2004;198:570–576. doi:10.1016/j.jamcollsurg.2003.11.022.

    Article  PubMed  Google Scholar 

  17. Miwa S, Kobayashi A, Akahane Y et al. Is major hepatectomy with pancreatoduodenectomy justified for advanced biliary malignancy? J Hepatobiliary Pancreat Surg 2007;14:136–141. doi:10.1007/s00534-006-1107-3.

    Article  PubMed  Google Scholar 

  18. Tsukada K, Yoshida K, Aono T et al. Major hepatectomy and pancreatoduodenectomy for advanced carcinoma of the biliary tract. Br J Surg 1994;81:108–110. doi:10.1002/bjs.1800810139.

    Article  PubMed  CAS  Google Scholar 

  19. Wente MN, Bassi C, Dervenis C et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007;142:761–768. doi:10.1016/j.surg.2007.05.005.

    Article  PubMed  Google Scholar 

  20. Bassi C, Dervenis C, Butturini G et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8–13. doi:10.1016/j.surg.2005.05.001.

    Article  PubMed  Google Scholar 

  21. Cameron JL, Riall TS, Coleman J et al. One thousand consecutive pancreaticoduodenectomies. Ann Surg 2006;244:10–15. doi:10.1097/01.sla.0000217673.04165.ea.

    Article  PubMed  Google Scholar 

  22. Ota T, Araida T, Yamamoto M et al. Operative outcome and problems of right hepatic lobectomy with pancreatoduodenectomy for advanced carcinoma of the biliary tract. J Hepatobiliary Pancreat Surg 2007;14:155–158. doi:10.1007/s00534-006-1110-8.

    Article  PubMed  Google Scholar 

  23. Suzuki Y, Fujino Y, Tanioka Y et al. Resection of the colon simultaneously with pancreaticoduodenectomy for tumors of the pancreas and periampullary region: short-term and long-term results. World J Surg 2004;28:1007–1010. doi:10.1007/s00268-004-7438-9.

    Article  PubMed  Google Scholar 

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Correspondence to Kevin F. Staveley-O’Carroll.

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Nikfarjam, M., Sehmbey, M., Kimchi, E.T. et al. Additional Organ Resection Combined with Pancreaticoduodenectomy does not Increase Postoperative Morbidity and Mortality. J Gastrointest Surg 13, 915–921 (2009).

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