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Extended pancreatectomy as defined by the ISGPS: useful in selected cases of pancreatic cancer but invaluable in other complex pancreatic tumors

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Abstract

Purpose

Extended pancreatectomy aimed at R0 resection of pancreatic tumors with adjacent vessel and organ involvement may be the only option for cure. This study was done with an objective to analyze the short- and long-term outcomes of extended pancreatic resections.

Methods

All pancreatectomies performed between 2006 and 2015 were included. The pancreatectomies were classified as standard or extended, as per the International Study Group for Pancreatic Surgery. All surgical complications and terminologies were according to Clavien-Dindo classification and International Study Group for Pancreatic Surgery guidelines. Morbidity and mortality were primary outcomes and disease-free survival was a secondary outcome.

Results

Sixty-three extended and 620 standard pancreatectomies were performed. Major morbidity (Clavien grades III, IV and V) (37 vs. 29%, p = 0.21) and mortality (6 vs. 4%, p = 0.3) for extended pancreatectomies were comparable to those for standard pancreatectomies. Blood loss > 855 ml, need for blood transfusion, and tumor size were independent risk factors for morbidity, and the latter two for mortality. Standard pancreatectomies were associated with better 3-year disease-free survival than extended pancreatectomies (67 vs. 41%, p < 0.001). Extended pancreatectomies resulted in a significantly better median disease-free survival for non-pancreatic adenocarcinoma vs. pancreatic adenocarcinoma (33.3 vs. 9.5 months, p = 0.01).

Conclusion

Extended pancreatectomies resulted in similar peri-operative morbidity and mortality compared to standard pancreatectomies. Although the survival of patients undergoing these complex procedures is inferior to standard pancreatectomies, they should be undertaken not only in selected cases of pancreatic cancer but even more so in other complex pancreatic tumors.

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Authors and Affiliations

  1. Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, 400 012, India

    Abhishek Mitra, Esha Pai, Ashwin DeSouza, Mahesh Goel & Shailesh V. Shrikhande

  2. Department of Statistics, Tata Memorial Hospital, Mumbai, India

    Rohit Dusane

  3. Department of Anesthesiology, Tata Memorial Hospital, Mumbai, India

    Priya Ranganathan

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  1. Abhishek Mitra
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  2. Esha Pai
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  4. Priya Ranganathan
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Contributions

Abhishek Mitra—acquisition of data, analysis, interpretation of data, drafting of manuscript, critical revision of manuscript; Esha Pai—acquisition of data, analysis, interpretation of data, drafting of manuscript; Priya Ranganathan—analysis and interpretation of data, critical revision of manuscript; Ashwin DeSouza—critical revision of manuscript; Mahesh Goel—critical revision of manuscript; Shailesh V. Shrikhande—study conception and design, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript.

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Correspondence to Shailesh V. Shrikhande.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Abhishek Mitra and Esha Pai share first authorship.

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Mitra, A., Pai, E., Dusane, R. et al. Extended pancreatectomy as defined by the ISGPS: useful in selected cases of pancreatic cancer but invaluable in other complex pancreatic tumors. Langenbecks Arch Surg 403, 203–212 (2018). https://doi.org/10.1007/s00423-018-1653-6

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