Indication for en bloc pancreatectomy with colectomy: when is it safe?

Patrick B. Schwartz, Alexandra M. Roch, Jane S. Han, Alex V. Vaicius, William P. Lancaster, E. Molly Kilbane, Michael House, Nicholas Zyromski, C. Schmidt, Attila Nakeeb, Eugene P. Ceppa

Research output: Contribution to journalArticle

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Abstract

Introduction: Aggressive en bloc resection of adjacent organs is often necessary to resect pancreatic or colonic lesions. However, it is debated whether simultaneous pancreatectomy with colectomy (P+C) is warranted as it potentially increases morbidity and mortality (MM). We hypothesized that MM would be increased in P+C, especially in cases of pancreatitis. Methods: All patients who underwent pancreatectomy (P) and simultaneous pancreatectomy with colectomy (P+C) at a high-volume center from November 2006 to 2015 were prospectively collected using ACS-NSQIP at our institution. Patients with additional multivisceral or enucleation procedures were excluded. Data were augmented to 90-day outcomes using our institutional database. Results: Forty-three patients with a mean age of 62 years (27:16 male: female) underwent P+C, accounting for 2.39% (43/1797) of pancreatectomies performed. Pancreatoduodenectomy (PD) was performed in 61% (n = 26), distal pancreatectomy (DP) in 37% (n = 16), and total pancreatectomy (TP) in 2% (n = 1) of patients. The 30- and 90-day MM were higher in P+C than P (30-day: 54 vs. 37%, p = 0.037 and 9 vs. 2%, p = 0.022; 90-day: 61 vs. 42%, p = 0.019 and 14 vs. 3%, p = 0.002). Logistical regression modeling revealed an association between 90-day mortality and colectomy (p = 0.013, OR = 3.556). When P+C MM were analyzed according to intraoperative factors, there was no significant difference according to type of pancreatectomy (PD vs. DP vs. TP), origin of primary lesion (pancreas vs. colon), surgical indication (malignant vs. non-malignant), or case status (planned colectomy vs. intraoperative decision). Conclusions: Addition of colectomy to pancreatectomy substantially increased MM. Subanalysis revealed that type of resection performed, etiology, and planning status did not account for increased risk when performing P+C. However, colectomy was found to be an independent risk factor for mortality. Therefore, patients should be informed of the risk of increased postoperative complications until a further study can identify potential patients or perioperative factors that can be used for risk stratification.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalSurgical Endoscopy and Other Interventional Techniques
DOIs
StateAccepted/In press - Jun 29 2017

Fingerprint

Pancreatectomy
Colectomy
Mortality
Morbidity
Pancreaticoduodenectomy
Pancreatitis
Pancreas
Colon
Databases

Keywords

  • Colectomy
  • Morbidity
  • Mortality
  • Multivisceral
  • Pancreatectomy

ASJC Scopus subject areas

  • Surgery

Cite this

Schwartz, P. B., Roch, A. M., Han, J. S., Vaicius, A. V., Lancaster, W. P., Kilbane, E. M., ... Ceppa, E. P. (Accepted/In press). Indication for en bloc pancreatectomy with colectomy: when is it safe? Surgical Endoscopy and Other Interventional Techniques, 1-8. https://doi.org/10.1007/s00464-017-5700-0

Indication for en bloc pancreatectomy with colectomy : when is it safe? / Schwartz, Patrick B.; Roch, Alexandra M.; Han, Jane S.; Vaicius, Alex V.; Lancaster, William P.; Kilbane, E. Molly; House, Michael; Zyromski, Nicholas; Schmidt, C.; Nakeeb, Attila; Ceppa, Eugene P.

In: Surgical Endoscopy and Other Interventional Techniques, 29.06.2017, p. 1-8.

Research output: Contribution to journalArticle

Schwartz, Patrick B. ; Roch, Alexandra M. ; Han, Jane S. ; Vaicius, Alex V. ; Lancaster, William P. ; Kilbane, E. Molly ; House, Michael ; Zyromski, Nicholas ; Schmidt, C. ; Nakeeb, Attila ; Ceppa, Eugene P. / Indication for en bloc pancreatectomy with colectomy : when is it safe?. In: Surgical Endoscopy and Other Interventional Techniques. 2017 ; pp. 1-8.
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abstract = "Introduction: Aggressive en bloc resection of adjacent organs is often necessary to resect pancreatic or colonic lesions. However, it is debated whether simultaneous pancreatectomy with colectomy (P+C) is warranted as it potentially increases morbidity and mortality (MM). We hypothesized that MM would be increased in P+C, especially in cases of pancreatitis. Methods: All patients who underwent pancreatectomy (P) and simultaneous pancreatectomy with colectomy (P+C) at a high-volume center from November 2006 to 2015 were prospectively collected using ACS-NSQIP at our institution. Patients with additional multivisceral or enucleation procedures were excluded. Data were augmented to 90-day outcomes using our institutional database. Results: Forty-three patients with a mean age of 62 years (27:16 male: female) underwent P+C, accounting for 2.39{\%} (43/1797) of pancreatectomies performed. Pancreatoduodenectomy (PD) was performed in 61{\%} (n = 26), distal pancreatectomy (DP) in 37{\%} (n = 16), and total pancreatectomy (TP) in 2{\%} (n = 1) of patients. The 30- and 90-day MM were higher in P+C than P (30-day: 54 vs. 37{\%}, p = 0.037 and 9 vs. 2{\%}, p = 0.022; 90-day: 61 vs. 42{\%}, p = 0.019 and 14 vs. 3{\%}, p = 0.002). Logistical regression modeling revealed an association between 90-day mortality and colectomy (p = 0.013, OR = 3.556). When P+C MM were analyzed according to intraoperative factors, there was no significant difference according to type of pancreatectomy (PD vs. DP vs. TP), origin of primary lesion (pancreas vs. colon), surgical indication (malignant vs. non-malignant), or case status (planned colectomy vs. intraoperative decision). Conclusions: Addition of colectomy to pancreatectomy substantially increased MM. Subanalysis revealed that type of resection performed, etiology, and planning status did not account for increased risk when performing P+C. However, colectomy was found to be an independent risk factor for mortality. Therefore, patients should be informed of the risk of increased postoperative complications until a further study can identify potential patients or perioperative factors that can be used for risk stratification.",
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T1 - Indication for en bloc pancreatectomy with colectomy

T2 - when is it safe?

AU - Schwartz, Patrick B.

AU - Roch, Alexandra M.

AU - Han, Jane S.

AU - Vaicius, Alex V.

AU - Lancaster, William P.

AU - Kilbane, E. Molly

AU - House, Michael

AU - Zyromski, Nicholas

AU - Schmidt, C.

AU - Nakeeb, Attila

AU - Ceppa, Eugene P.

PY - 2017/6/29

Y1 - 2017/6/29

N2 - Introduction: Aggressive en bloc resection of adjacent organs is often necessary to resect pancreatic or colonic lesions. However, it is debated whether simultaneous pancreatectomy with colectomy (P+C) is warranted as it potentially increases morbidity and mortality (MM). We hypothesized that MM would be increased in P+C, especially in cases of pancreatitis. Methods: All patients who underwent pancreatectomy (P) and simultaneous pancreatectomy with colectomy (P+C) at a high-volume center from November 2006 to 2015 were prospectively collected using ACS-NSQIP at our institution. Patients with additional multivisceral or enucleation procedures were excluded. Data were augmented to 90-day outcomes using our institutional database. Results: Forty-three patients with a mean age of 62 years (27:16 male: female) underwent P+C, accounting for 2.39% (43/1797) of pancreatectomies performed. Pancreatoduodenectomy (PD) was performed in 61% (n = 26), distal pancreatectomy (DP) in 37% (n = 16), and total pancreatectomy (TP) in 2% (n = 1) of patients. The 30- and 90-day MM were higher in P+C than P (30-day: 54 vs. 37%, p = 0.037 and 9 vs. 2%, p = 0.022; 90-day: 61 vs. 42%, p = 0.019 and 14 vs. 3%, p = 0.002). Logistical regression modeling revealed an association between 90-day mortality and colectomy (p = 0.013, OR = 3.556). When P+C MM were analyzed according to intraoperative factors, there was no significant difference according to type of pancreatectomy (PD vs. DP vs. TP), origin of primary lesion (pancreas vs. colon), surgical indication (malignant vs. non-malignant), or case status (planned colectomy vs. intraoperative decision). Conclusions: Addition of colectomy to pancreatectomy substantially increased MM. Subanalysis revealed that type of resection performed, etiology, and planning status did not account for increased risk when performing P+C. However, colectomy was found to be an independent risk factor for mortality. Therefore, patients should be informed of the risk of increased postoperative complications until a further study can identify potential patients or perioperative factors that can be used for risk stratification.

AB - Introduction: Aggressive en bloc resection of adjacent organs is often necessary to resect pancreatic or colonic lesions. However, it is debated whether simultaneous pancreatectomy with colectomy (P+C) is warranted as it potentially increases morbidity and mortality (MM). We hypothesized that MM would be increased in P+C, especially in cases of pancreatitis. Methods: All patients who underwent pancreatectomy (P) and simultaneous pancreatectomy with colectomy (P+C) at a high-volume center from November 2006 to 2015 were prospectively collected using ACS-NSQIP at our institution. Patients with additional multivisceral or enucleation procedures were excluded. Data were augmented to 90-day outcomes using our institutional database. Results: Forty-three patients with a mean age of 62 years (27:16 male: female) underwent P+C, accounting for 2.39% (43/1797) of pancreatectomies performed. Pancreatoduodenectomy (PD) was performed in 61% (n = 26), distal pancreatectomy (DP) in 37% (n = 16), and total pancreatectomy (TP) in 2% (n = 1) of patients. The 30- and 90-day MM were higher in P+C than P (30-day: 54 vs. 37%, p = 0.037 and 9 vs. 2%, p = 0.022; 90-day: 61 vs. 42%, p = 0.019 and 14 vs. 3%, p = 0.002). Logistical regression modeling revealed an association between 90-day mortality and colectomy (p = 0.013, OR = 3.556). When P+C MM were analyzed according to intraoperative factors, there was no significant difference according to type of pancreatectomy (PD vs. DP vs. TP), origin of primary lesion (pancreas vs. colon), surgical indication (malignant vs. non-malignant), or case status (planned colectomy vs. intraoperative decision). Conclusions: Addition of colectomy to pancreatectomy substantially increased MM. Subanalysis revealed that type of resection performed, etiology, and planning status did not account for increased risk when performing P+C. However, colectomy was found to be an independent risk factor for mortality. Therefore, patients should be informed of the risk of increased postoperative complications until a further study can identify potential patients or perioperative factors that can be used for risk stratification.

KW - Colectomy

KW - Morbidity

KW - Mortality

KW - Multivisceral

KW - Pancreatectomy

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