Defining risk factors and outcomes in 537 patients with simultaneous liver and pancreas resection

Abstract

Background: As HPB surgery has become safer, a larger number of combined liver/pancreas (L/P) resections are being performed. Methods: 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.