Abstract
Background: As HPB surgery has become safer, a larger number of combined liver/pancreas (L/P) resections are being performed. Method: All elective operations with both a hepatectomy (partial lobectomy(PL), left lobectomy(LL), right lobectomy(RL), or trisectionectomy(TS)) and simultaneous pancreatectomy (pancreatoduodenectomy(PD), distal(DP), or total pancreatectomy(TP)) were identified in the 2005-2014 American College of Surgeons National Surgical Quality Improvement Project database. Operations were categorized based on combined magnitude of resection as basic (PL/LL & DP), major (RL/TS & DP or PL/LL & PD/TP), and extreme (RL/TS & PD/TP). Risk factors and outcomes were assessed with standard statistical methods. Results: 537 patients underwent combined L/P operations with 241 basic(B), 275 major(M) and 21 extreme(E). The number of operations has increased from 103 (2005-2009) to 434 (2010-2014). Increasing magnitude of resection was associated with longer median operative time (B: 283/ M: 372/ E: 484 minutes), median length of stay (B: 7/ M: 9/ E: 12 days), severe complication (SC) rates (B: 21.2%/ M: 37.8%/ E: 52.4%, p<0.001) and 30-day mortality rates (B: 1.2%/ M 6.2%/ E 18.2%, p=0.008). After controlling for cancer types, multivariate analysis demonstrated that E/M vs. B was predictive of SC (OR 2.74, p=0.029). Conclusion: Simultaneous L/P resection is an increasingly frequent procedure associated with significant morbidity and mortality when complex liver and complex pancreas resection are combined.
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