Arida Siripong1,2*, Mathew Chung1,2,3 and Shayna E Rich4
1Department of General Surgery, Michigan State University General Surgery Residency Program, USA
2Department of Surgery, Grand Rapids Medical Educational Partners, USA
3Department of Surgery, Spectrum Health Medical Group, USA
4Department of Surgery, University of Florida Radiation Oncology Residency Program, USA
Introduction: As mortality associated with pancreatic surgery decreases, there has been an increasing drive towards extended resections for locally advanced pancreatic cancer. However, the overall impact of multivisceral resections on morbidity and mortality remains unclear.Methods: An IRB-approved retrospective chart review was conducted amongst patients who underwent pancreatic resection by a surgical oncologist at a single institution between July 2005 and July 2010. Patients were grouped into four categories based on extent of resection: Standard Whipple (SW), Multivisceral Whipple (MVW), Distal Pancreatectomy (DP) and Multivisceral Distal Pancreatectomy (MVDP). Measured variables included demographics, Length of Stay (LOS), operating room time, margin status, postoperative morbidity, 30-day mortality, and median survival.Results: 192 patients were identified, with 145 who underwent standard and 47 multivisceral (MV) resections. Demographics were similar between the two groups. Multivisceral procedures were associated with a higher incidence of positive margins (40.5% vs. 22.9%, p=0.01), longer operating times (4.9 vs. 3.8 hours, p<0.001), and increased surgical complications (55.3% vs. 34.7%, p=0.012). 30-day mortality was comparable between all groups, but survival was significantly shorter in patients who underwent multivisceral compared to standard resections (22 months vs. 11 months, p=0.002).Conclusion: Although multivisceral pancreatic resections may be performed with acceptable morbidity and mortality in the appropriate patient population, there does not appear to be a survival benefit.
Siripong A, Chung M, Rich SE. Multivisceral Pancreatic Resections: Worth the Risk? Clin Surg. 2018; 3: 1869.