Hepato‐pancreatectomy: how morbid? Results from the national surgical quality improvement project

E-ISSN： 1477-2574|17|9|763-769

ISSN： 1365-182x

Source： HPB, Vol.17, Iss.9, 2015-09, pp. : 763-769

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Abstract

AbstractBackgroundSimultaneous resection of both the liver and the pancreas carries significant complexity. The objective of this study was to investigate peri‐operative outcomes after a synchronous hepatectomy and pancreatectomy (SHP).MethodsThe American College of Surgeons National Surgical Quality Improvement Project database was queried to identify patients who underwent SHP. Resections were categorized as ‘< hemihepatectomy’, ‘≥ hemihepatectomy’ (hemihepatectomy and trisectionectomy), ‘PD’ (pancreaticoduodenectomy and total pancreatectomy) and ‘distal’ (distal pancreatectomy and enucleation).ResultsFrom 2005 to 2013, 480 patients underwent SHP. Patients were stratified based on the extent of resection: ‘< hemihepatectomy + distal (n = 224)’, ‘≥ hemihepatectomy + distal’ (n = 49), ‘< hemihepatectomy + PD’ (n = 83) and ‘≥ hemihepatectomy + PD’ (n = 24). Although the first three groups had a reasonable and comparable safety profile (morbidity 33–51% and mortality 0–6.6%), the ‘≥ hemihepatectomy + PD’ group was associated with an 87.5% morbidity (organ space infection 58.3%, re‐intubation 12.5%, reoperation 25% and septic shock 25%), 8.3% 30‐day mortality and 18.2% in‐hospital mortality.ConclusionsA synchronous hemihepatectomy (or trisectionectomy) with PD remains a highly morbid combination and should be reserved for patients who have undergone extremely cautious selection.