Multivisceral resection morbidity for left pancreas cancer

Objectives

We sought to define the attributable morbidity of multivisceral resection (MVR) during distal/subtotal pancreatectomy (DP) in patients with pancreatic ductal adenocarcinoma (PDAC).

Methods

This retrospective review of patients with PDAC used the 2014–2019 pancreas-targeted American College of Surgeons National Surgical Quality Improvement Program database. Operations DP versus MVR were compared based on demographics, comorbidities, intraoperative variables, and postoperative outcomes. Univariate and multivariable logistic regression models assessed morbidity and mortality.

Results

Of 3353 distal pancreatectomies, 124 (4%) were MVR. MVR patients were more likely male (56% versus 49%) and smokers (24% versus 18%) but less likely obese (18% versus 29%) or diabetic (21% versus 30%). MVR operations were longer (median 4.3 versus 3.8 h) and involved partial colectomy (100%), gastrectomy (28%), adrenalectomy (20%), and enterectomy (13%). MVR patients had higher unadjusted rates of mortality (2.4% versus 1.1%), serious morbidity (30.7% versus 14.1%), and overall morbidity (61% versus 36%). MVR patients had higher adjusted risk for serious morbidity [odds ratio (OR) 2.13, 95% confidence intervals: 1.28–3.43] and infectious complications [OR 2.75 (1.73–4.31)], but not mortality [OR 1.05 (0.04–3.73)], although the mortality analyses were underpowered.

Conclusions

Concurrent MVR during DP doubled the risk of postoperative complications. This should be considered during the sequencing of cancer-directed care and preoperative planning.