Pancreatoduodenectomy with colon resection for cancer: A nationwide retrospective analysis

E. Madelief Marsman, Thijs de Rooij, Casper H. van Eijck, Djamila Boerma, Bert A. Bonsing, Ronald M. van Dam, Susan van Dieren, Joris I. Erdmann, Michael F. Gerhards, Ignace H. de Hingh, Geert Kazemier, Joost Klaase, I. Quintus Molenaar, Gijs A. Patijn, Joris J. Scheepers, Pieter J. Tanis, Olivier R. Busch, Marc G. Besselink*, Dutch Pancreatic Canc Grp

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Scopus)

Abstract

Background. Microscopically radical (RO) resection of pancreatic, periampullary, or colon cancer may occasionally require a pancreatoduodenectomy with colon resection (PD-colon), but the benefits of this procedure have been disputed, and multicenter studies on morbidity and oncologic outcomes after PD-colon are lacking. This study aimed to assess complications and survival after PD-colon.

Methods. Patients who had undergone PD-colon from 2004-2014 in 1 of 13 centers were analyzed retrospectively. Ninety-day morbidity was scored using the Clavien-Dindo score and the Comprehensive Complication Index (CCI, 0 = no complications, 100 = death). Survival was analyzed per histopathologic diagnosis.

Results. After screening 3,218 consecutive PDs, 50 (1.6%) PD-colon patients (median age 66 years [interquartile range 55-72], 33 [66%] men) were included. Twenty-three (46%) patients had pancreatic ductal adenocarcinoma (PDAC), 19 (38%) other pathology, and 8 (16%) colon cancer. Ninety-day Clavien-Dindo >= 3 complications occurred in 30 (60%) patients without differences per diagnosis (P > .99); mean CCI was 39 (standard deviation 27). Colonic anastomosis leak, pancreatic fistula, and 90-day mortality occurred in 3 (6%), 2 (4%), and 4 (8%) patients, respectively. A total of 11/23 (48 %) patients with PDAC and 8/8 (100%) patients with colon cancer underwent an RO resection. Patients with PDAC had a median postoperative survival of 13 months (95 % confidence interval = 5-21). One-, 3-, and 5-year cumulative survival was 56 %, 21 %, and 14 %, respectively. Median survival after RO resection for PDAC was 21 months (95 % confidence interval = 6-35). All patients with colon cancer were alive at end of follow-up (median 24 months [95 % confidence interval = 9-110]).

Conclusion. In this retrospective, multicenter study, PD-colon was associated with considerable complications and acceptable survival rates when a tumor negative resection margin was achieved.

Original languageEnglish
Pages (from-to)145-152
Number of pages8
JournalSurgery
Volume160
Issue number1
DOIs
Publication statusPublished - Jul-2016
Externally publishedYes

Keywords

  • INTERNATIONAL STUDY-GROUP
  • PANCREATIC SURGERY ISGPS
  • EN-BLOC PANCREATICODUODENECTOMY
  • METASTATIC COLORECTAL-CANCER
  • LONG-TERM OUTCOMES
  • DUODENAL ADENOCARCINOMA
  • ADJUVANT CHEMOTHERAPY
  • RECTAL-CANCER
  • RISK-FACTORS
  • MULTIVISCERAL RESECTION

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