Patrick B Schwartz, BS1, Alexandra M Roch, MD, MS1, William P Lancaster, MD1, E M Killbane, RN, BSN2, Michael G House, MD1, Nicholas J Zyromski, MD1, C M Schmidt, MD, PhD, MBA1, Atilla Nakeeb, MD1, Eugene P Ceppa, MD1. 1Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, 2Department of Nursing, Indiana University Health, Indianapolis, IN
Introduction: Aggressive en bloc resection of adjacent organs is often necessary to completely resect pancreatic or colonic lesions. However, it is currently debated whether simultaneous pancreatectomy with colectomy (P+C) is warranted as it increases morbidity and mortality compared to either operation alone. We hypothesized that morbidity and mortality would be increased in P+C, especially in cases of acute and chronic pancreatitis.
Methods: All consecutive patients who underwent pancreatectomy (P) and simultaneous pancreatectomy with colectomy (P+C) at a single high volume center from November 2006-2015 were prospectively included in this study using the ACS-NSQIP database. Patients with additional multivisceral procedures or parenchyma-sparing pancreatectomy were excluded. Data was augmented to 90-day outcomes in both groups using our institutional pancreatic database.
Results: Forty-four patients with a mean age of 59 years (28:16 male:female) underwent P+C; accounting for 2.44% (n=44/1800) of total pancreatectomies performed . Pancreatoduodenectomy (PD) was performed in 61.3% (n=27), distal pancreatectomy (DP) in 36.4% (n=16) and total pancreatectomy (TP) in 2.3% (n=1) of patients. The 30-day morbidity and mortality were higher in P+C than P (50% vs. 27%, p=0.002 and 9% vs. 2%, p=0.013); this was seen for 90-days as well. Median operative time (352 vs. 275; p<0.001) and LOS (13 vs. 7; p<0.001) were found to be significantly increased in P+C than in P. Pancreatic fistula rates were comparable across P and P+C (Type A = 11.4%, B = 4.55%, C = 4.55%, p=0.154). Logistical regression modeling showed no association between 30-day morbidity and colectomy (p=0.441). When P+C morbidity and mortality was analyzed according to intraoperative factors, there was no statistically significant difference according to type of pancreatectomy (PD vs. DP), origin of primary lesion (pancreas vs. colon), indication for surgery (malignant vs. non-malignant) or case status (planned colectomy vs. intraoperative decision).
Conclusions: Although addition of colectomy to pancreatectomy substantially increases morbidity and mortality, colectomy in itself is not an independent risk factor for additional morbidity. Further, subanalysis revealed the type of pancreatic resection performed, etiology (pancreatic or colonic, malignant or benign) and planning status did not account for increased risk when performing colectomy with pancreatectomy. Therefore, patients should be informed, in advance, of the risk of postoperative complications. However, indications for additional colectomy should be broader, if required, to achieve complete resection during pancreatectomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80217
Program Number: P460
Presentation Session: Poster (Non CME)
Presentation Type: Poster