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Distal Pancreatectomy Combined with Multivisceral Resection Is Associated with Postoperative Complication Rates and Survival Comparable to Those After Standard Procedures

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

For pancreatic tumors located in the body or tail of the pancreas, distal pancreatectomy (DP) remains the surgical procedure of choice to achieve radical tumor removal. Purpose of this study was to evaluate outcome and overall survival of patients who underwent DP combined with multivisceral resection (MVR).

Methods

Retrospective single-center case-matched analysis. Between January 1994 and June 2014, 494 consecutive patients were entered into a prospective database, and 126 patients undergoing DP + MVR (cases) were matched with 126 patients undergoing DP (controls) for gender, age, and underlying final diagnosis.

Results

There were no significant differences in patient demographics. Rates of postoperative pancreatic fistula (POPF) (36 (28.6%) vs. 29 (23.0%); p = 0.388) and postpancreatectomy hemorrhage (PPH) (7 (5.5%) vs. 5 (3.9%); p = 0.769) did not reveal any significant differences. Although operative time (237.8 ± 57.9 vs. 203.5 ± 34.5; p < 0.001) and the necessity for intraoperative transfusions (18 (14.3%) vs. 5 (4.0%); p < 0.001) was significantly higher, the number of patients with major complications (the Clavien-Dindo ≥ 3) was not increased (27 (19.8%) vs. 20 (15.9%); p = 0.332) in the DP + MVR group. Midterm survival analysis indicated no significant difference for adenocarcinoma and neuroendocrine tumors for either group.

Conclusion

DP + MVR is a feasible and safe surgical procedure to achieve radical tumor removal and can offer beneficial survival outcomes. Although operative time and intraoperative transfusions are enhanced, POPF, PPH, or major complications (the Clavien-Dindo ≥ 3) are not significantly increased after DP + MVR. DP + MVR can therefore be recommended in selected patients for resection of extended tumors within the concept of interdisciplinary strategies.

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Authors and Affiliations

  1. Department of Surgery, Charité Campus Mitte and Charité Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Thomas Malinka, Fritz Klein, Andreas Andreou, Johann Pratschke & Marcus Bahra

Authors
  1. Thomas Malinka
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  2. Fritz Klein
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  3. Andreas Andreou
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  4. Johann Pratschke
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  5. Marcus Bahra
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Contributions

Substantial contributions to the conception or design of the work: TM, FK, AA, JP, MB. Acquisition, analysis, or interpretation of data for the work: TM, FK, AA, JP, MB. Drafting the work or revising it critically for important intellectual content: TM, FK, AA, JP, MB. Final approval of the version to be published: TM, FK, AA, JP, MB.

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Correspondence to Thomas Malinka.

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The authors declare that they have no conflict of interest.

Additional information

This study was presented as oral presentation at Viszeralmedizin 2017, Dresden, September 13–16, 2017.

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Malinka, T., Klein, F., Andreou, A. et al. Distal Pancreatectomy Combined with Multivisceral Resection Is Associated with Postoperative Complication Rates and Survival Comparable to Those After Standard Procedures. J Gastrointest Surg 22, 1549–1556 (2018). https://doi.org/10.1007/s11605-018-3804-z

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  • DOI: https://doi.org/10.1007/s11605-018-3804-z

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