Hepato-pancreatectomy: how morbid? Results from the national surgical quality improvement project. Issue 9 (September 2015)

• Record Type: Journal Article
• Authors: Tran, Thuy B.; Dua, Monica M.; Spain, David A.; Visser, Brendan C.; Norton, Jeffrey A.; Poultsides, George A.
• Is Part Of: HPB. Volume 17:Issue 9(2015:Sep.)
• Page Start: 763
• Page End: 769
• Publication Date: 2015-09
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/hpb.12426
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: Simultaneous resection of both the liver and the pancreas carries significant complexity. The objective of this study was to investigate peri-operative outcomes after a synchronous hepatectomy and pancreatectomy (SHP). Methods: The American College of Surgeons National Surgical Quality Improvement Project database was queried to identify patients who underwent SHP. Resections were categorized as '< hemihepatectomy', '≥ hemihepatectomy' (hemihepatectomy and trisectionectomy), 'PD' (pancreaticoduodenectomy and total pancreatectomy) and 'distal' (distal pancreatectomy and enucleation). Results: From 2005 to 2013, 480 patients underwent SHP. Patients were stratified based on the extent of resection: '< hemihepatectomy + distal ( n = 224)', '≥ hemihepatectomy + distal' ( n = 49), '< hemihepatectomy + PD' ( n = 83) and '≥ hemihepatectomy + PD' ( n = 24). Although the first three groups had a reasonable and comparable safety profile (morbidity 33–51% and mortality 0–6.6%), the '≥ hemihepatectomy + PD' group was associated with an 87.5% morbidity (organ space infection 58.3%, re-intubation 12.5%, reoperation 25% and septic shock 25%), 8.3% 30-day mortality and 18.2% in-hospital mortality. Conclusions: A synchronous hemihepatectomy (or trisectionectomy) with PD remains a highly morbid combination and should be reserved for patients who have undergone extremely cautious selection.