Multivisceral and extended resections during pancreatoduodenectomy increase morbidity and mortality

Neil H. Bhayani, Laura M. Enomoto, Ben C. James, Gail Ortenzi, Jussuf T. Kaifi, Eric T. Kimchi, Kevin F. Staveley-O'Carroll, Niraj J. Gusani

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

Background Improvements in outcomes after pancreatoduodenectomy (PD) have permitted more complex resections. Complete extirpation at PD may require multivisceral resection (MVR-PD); however, descriptions of morbidity of MVR-PD are limited to small, single-institution series. Methods The National Surgical Quality Improvement Project database (2005-2011) was used to compare 30-day postoperative morbidity of PD with MVR-PD. Concurrent resection of colon, small bowel, stomach, kidney, or adrenal gland defined MVR-PD. Results Of 9,927 PDs, MVR-PD was performed in 273 patients (3%). MVR included colon (58%), small bowel (30%), and gastric (12%) resections. Preoperative comorbidities were similar between groups. Pancreatic, duodenal, or periampullary cancer was present in 75% of patients. Mortality (8.8% vs 2.9%) and major morbidity (56.8% vs 30.8%) were much greater for MVR-PD versus PD alone (P <.001). MVR-PD patients also experienced greater rates of wound, pulmonary, cardiac, thromboembolic, renal, and septic complications. On multivariable regression, MVR was an independent predictor of death (odds ratio [OR], 3.4; P <.001), overall morbidity (OR, 3.01; P <.001), major morbidity (OR, 3.21; P <.001), and minor morbidity (OR, 1.65; P =.03). Among patients undergoing PD+MVR, colectomy was an independent predictor of increased overall morbidity (OR, 1.96; P =.03) and major morbidity (OR, 1.90; P =.02). Conclusion Margin-negative resection may require MVRs at the time of PD. MVR at is associated with 3-fold mortality and substantial morbidity after adjusting for comorbidities. Colectomy independently predicted major morbidity. At PD, the morbidity of MVR should be approached with caution when attempting margin-negative resection.

Original languageEnglish (US)
Pages (from-to)567-574
Number of pages8
JournalSurgery (United States)
Volume155
Issue number3
DOIs
StatePublished - Mar 2014

All Science Journal Classification (ASJC) codes

  • Surgery

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