Morbidity of Colectomy at the Time of Distal Pancreatectomy: An Analysis of the Pancreas-Targeted American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Database

Abstract

Introduction: Distal pancreatectomy is commonly performed for tumors of the pancreatic body and tail. Depending on the location and extent of the tumor, a concurrent colectomy is often indicated. We sought to define the perioperative risk of concurrent colectomy during distal pancreatectomy. Methods: This was a retrospective review of the 2014-2019 pancreas-targeted American College of Surgeons National Surgical Quality Improvement Program database. Operations were classified as DP versus distal pancreatectomy/colectomy (DP+C). The two groups were compared with respect to demographics, comorbidities, intraoperative variables, and postoperative outcomes. The 30-day mortality and morbidity associated with concurrent colectomy were assessed using univariate and multivariable logistic regression models. Results: Out of 11,883 distal pancreatectomies, 437 (4%) involved a concurrent colectomy. More DP+C patients were male (55% versus 45%) and had a diagnosis of pancreas cancer (78% versus 61%) and preoperative weight loss (12% versus 6%). DP+C operations were longer (median 4.7 versus 3.5 hours) and commonly involved additional organ resection (gastrectomy: 31% versus 6%, nephrectomy: 13% versus 1%, enterectomy: 14% versus 2%). DP+C patients had higher unadjusted risk of mortality (2.5% versus 0.9%), major morbidity (64% versus 34%) and infectious complications (37% versus 18%). Similarly, DP+C patients had higher adjusted risk for major morbidity [odds ratio (OR) 2.77, 95% confidence intervals: 2.18-3.53] and infectious complications [OR 2.41 (1.89-3.07)], but not mortality [OR 0.85 (0.25-2.20)]. Conclusion: Concurrent colectomy during distal pancreatectomy nearly tripled the adjusted risk of major complications but did not affect mortality. This should be considered during preoperative planning and multidisciplinary oncologic care.Tabled 1EP02D-060Postoperative Morbidity and Mortality of the Two GroupsPostoperative OutcomeDP (n= 11,446)DP+C (n= 437)p-valueMortality0.9%2.5%0.001Major Complication34%64%<0.001Any Complication38%69%<0.001Open-space SSI11%25%<0.001Sepsis/Septic Shock5%16%<0.001Pancreatic fistula (grade≥B)17%24%<0.001Unplanned return to OR3%9%<0.001Length of stay, days [median (IQR)]5 (4-7)9 (6-15)<0.001 Open table in a new tab