Distal pancreatectomy with celiac axis resection: what are the added risks?. Issue 9 (September 2015)

• Record Type: Journal Article
• Authors: Beane, Joal D.; House, Michael G.; Pitt, Susan C.; Molly Kilbane, E.; Hall, Bruce L.; Parmar, Abishek D.; Riall, Taylor S.; Pitt, Henry A.
• Is Part Of: HPB. Volume 17:Issue 9(2015:Sep.)
• Page Start: 777
• Page End: 784
• Publication Date: 2015-09
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/hpb.12453
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: Reported series of a distal pancreatectomy with celiac axis resection (DP‐CAR) are either small or not adequately controlled. The aim of this analysis was to report a multicentre series of modified Appleby procedures with a comparison group to determine the relative operative risk. Methods: Data were gathered through the American College of Surgeons‐National Surgical Quality Improvement Program (ACS‐NSQIP) Pancreatectomy Demonstration Project. Over 14 months, 822 patients underwent a distal pancreatectomy at 43 institutions. Twenty of these patients (2.4%) also underwent a celiac axis resection. DP‐CAR patients were matched by age, gender, BMI, serum albumin, ASA class, gland texture, duct size and pathology to 172 patients undergoing DP alone. Results: The majority of DP and DP‐CAR patients had adenocarcinomas (61% and 60%). The median operative time for a DP alone was shorter than for a DP‐CAR (207 versus 276 min, P < 0.01). Post‐operative acute kidney injury (1% versus 10%, P < 0.03) and 30‐day mortality were higher after a DP‐CAR (1% versus 10%, P < 0.03). Conclusion: A distal pancreatectomy with celiac axis resection is associated with increased operative time, post‐operative acute kidney injury and a 10% operative mortality. The decision to offer a modified Appleby procedure for a body of pancreas tumour should be made with full disclosure of the increased risks.