Abstract
BackgroundAdenocarcinoma of the pancreatic body and tail is associated with a dismal prognosis. As patients frequently present themselves with locally advanced tumors, extended surgery including multivisceral resection is often necessary in order to achieve tumor-free resection margins. The aim of this study was to identify prognostic factors for postoperative morbidity and mortality and to evaluate the influence of multivisceral resections on patient outcome.MethodsThis is a retrospective analysis of 94 patients undergoing resection of adenocarcinoma located in the pancreatic body and/or tail between April 1995 and December 2016 at our institution. Uni- and multivariable Cox regression analysis was conducted to identify independent prognostic factors for postoperative survival.ResultsMultivisceral resections, including partial resections of the liver, the large and small intestines, the stomach, the left kidney and adrenal gland, and major vessels, were carried out in 47 patients (50.0%). The median postoperative follow-up time was 12.90 (0.16–220.92) months.Median Kaplan-Meier survival after resection was 12.78 months with 1-, 3-, and 5-year survival rates of 53.2%, 15.8%, and 9.0%. Multivariable Cox regression identified coeliac trunk resection (p = 0.027), portal vein resection (p = 0.010), intraoperative blood transfusions (p = 0.005), and lymph node ratio in percentage (p = 0.001) as independent risk factors for survival. Although postoperative complications requiring surgical revision were observed more frequently after multivisceral resections (14.9 versus 2.1%; p = 0.029), postoperative survival was not significantly inferior when compared to patients undergoing standard distal or subtotal pancreatectomy (12.35 versus 13.87 months; p = 0.377).ConclusionsOur data indicates that multivisceral resection in cases of locally advanced pancreatic carcinoma of the body and/or tail is justified, as it is not associated with increased mortality and can even facilitate long-term survival, albeit with an increase in postoperative morbidity. Simultaneous resections of major vessels, however, should be considered carefully, as they are associated with inferior survival.
Highlights
Adenocarcinoma of the pancreatic body and tail is associated with a dismal prognosis
The influence of the tumor localization has been a matter of great debate, data from large patient registries have demonstrated that lesions of the pancreatic body and tail, accounting for around 20 to 25% of the pancreatic adenocarcinomas, are associated with inferior survival, most likely as a result of a delayed diagnosis and a more aggressive tumor biology [6,7,8,9]
In order to optimize preoperative patient selection, we have evaluated the effects of multivisceral resections, among other variables, on the postoperative outcome in patients undergoing distal or subtotal pancreatectomy for ductal adenocarcinoma
Summary
Adenocarcinoma of the pancreatic body and tail is associated with a dismal prognosis. Severable risk factors impeding long-term survival have been identified in the past, including lymph node metastases, advanced tumor stage, positive resection margins, and distant disease, among others [4, 5]. The influence of the tumor localization has been a matter of great debate, data from large patient registries have demonstrated that lesions of the pancreatic body and tail, accounting for around 20 to 25% of the pancreatic adenocarcinomas, are associated with inferior survival, most likely as a result of a delayed diagnosis and a more aggressive tumor biology [6,7,8,9]. Reports are contradictory throughout the available literature, not least because data of patients with pancreatic head and body/tail lesions are often pooled [12, 13]
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