Distal pancreatectomy with multivisceral resection: A retrospective multicenter study - Case series
Por:
Ramia, J, del Rio-Martin, J, Blanco-Fernandez, G, Cantalejo-Diaz, M, Rotellar-Sastre, F, Sabater-Orti, L, Carabias-Hernandez, A, Manuel-Vazquez, A, Hernandez-Rivera, P, Jaen-Torrejimeno, I, Kalviainen-Mejia, H, Esteban-Gordillo, S, Munoz-Forner, E, De la Plaza, R, Longoria-Dubocq, T, De Armas-Conde, N, Pardo-Sanchez, F, Garces-Albir, M and Serradilla-Martin, M
Publicada:
1 oct 2020
Ahead of Print:
26 ago 2020
Resumen:
Background: Multivisceral resection (MVR) is sometimes necessary to achieve disease-free margins in cancer surgery. In certain patients with pancreatic tumors that invade neighboring organs these must be removed to perform an appropriate oncological surgery. In addition, there is an increasing need to perform resections of other organs like liver not directly invaded by the tumor but which require synchronous removal. The results of MVR in pancreatic surgery are controversial.
Material and methods: A distal pancreatectomy retrospective multicenter observational study using prospectively compiled data carried out at seven HPB Units. The period study was January 2008 to December 2018. We excluded DP with celiac trunk resection.
Results: 435 DP were performed. In 62 (14.25%) an extra organ was resected (82 organs). Comparison of the preoperative data of MVR and non-MVR patients showed that patients with MVR had lower BMI, higher ASA and larger tumor size. In the MVR group, the approach was mostly lapamtomic and spleen preservation was performed only in 8% of the cases, Blood loss and the percentage of intraoperative transfusion were higher in MVR group.
Major morbidity rates (Clavien > Ilia) and mortality (0.8vs.4.8%) were higher in the MVR group. Pancreatic fistula rates were practically the same in both groups. Mean hospital stay was twice as long in the MVR group and the readmission rate was higher in the MVR group. Histology study confirmed a much higher rate of malignant tumors in MVR group.
Conclusions: In order to obtain free margins or treat pathologies in several organs we think that DP + MVR is a feasible technique in selected patients; the results obtained are not as good as those of DP without MVR but are acceptable nonetheless.
Filiaciones:
:
Hosp Gen Univ Alicante, Dept Surg, Alicante, Spain
ISABIAL Inst Invest Sanitaria & Biomed Alicante, Alicante, Spain
del Rio-Martin, J:
Hosp Auxilio Mutuo, Dept Surg, San Juan, PR USA
Blanco-Fernandez, G:
Hosp Univ Infanta Cristina, Dept Surg, Badajoz, Spain
Cantalejo-Diaz, M:
Hosp Univ Miguel Servet, Dept Surg, Zaragoza, Spain
Rotellar-Sastre, F:
Clin Univ Navarra, Dept Surg, Pamplona, Spain
Sabater-Orti, L:
Univ Valencia, Hosp Clin, Biomed Res Inst, Dept Surg, Valencia, Spain
Carabias-Hernandez, A:
Hosp Univ Getafe, Getafe, Spain
Manuel-Vazquez, A:
Hosp Univ Guadalajara, Guadalajara, Spain
Hernandez-Rivera, P:
Univ Puerto Rico, Dept Surg, Sch Med, J Puerto Rico, PR USA
Jaen-Torrejimeno, I:
Hosp Univ Infanta Cristina, Dept Surg, Badajoz, Spain
Kalviainen-Mejia, H:
Hosp Univ Miguel Servet, Dept Surg, Zaragoza, Spain
Esteban-Gordillo, S:
Clin Univ Navarra, Dept Surg, Pamplona, Spain
Munoz-Forner, E:
Univ Valencia, Hosp Clin, Biomed Res Inst, Dept Surg, Valencia, Spain
De la Plaza, R:
Hosp Univ Guadalajara, Guadalajara, Spain
Longoria-Dubocq, T:
Univ Puerto Rico, Dept Surg, Sch Med, J Puerto Rico, PR USA
De Armas-Conde, N:
Hosp Univ Infanta Cristina, Dept Surg, Badajoz, Spain
Pardo-Sanchez, F:
Clin Univ Navarra, Dept Surg, Pamplona, Spain
Garces-Albir, M:
Univ Valencia, Hosp Clin, Biomed Res Inst, Dept Surg, Valencia, Spain
Serradilla-Martin, M:
Hosp Univ Miguel Servet, Inst Invest Sanitaria Aragon, Dept Surg, Zaragoza, Spain
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