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