Combined pancreas and liver therapies: Resection and ablation in hepato‐pancreatico‐biliary malignancies

Abstract

Combined pancreas and liver resection for metastatic disease should only be considered in highly selected patients. Tumor histology as well as BMI > 25 (overweight and obese patients) should be considered in the decision making process in an effort to minimize surgical morbidity while potentially improving survival.

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

“…Synchronous hepatectomy and PD is a procedure that is rarely performed, accounting for only 1% of all hepatic and pancreatic cases in the United States. Worldwide, there are fewer than 400 cases reported from the East and 100 cases from the West in the last 25 years. In the present study of 480 patients treated in North America, more extensive resections correlated with higher morbidity, longer hospital stay and longer operative time.…”

Safety and outcome of combined liver and pancreatic resections

“…With liver and pancreatic resections now being performed routinely with very low mortality and morbidity rates, there has been an increase in published studies describing combined liver and other organ resections for locally advanced and metastatic cancers. Over the past 14 years some small studies from Western centres have reported acceptable safety for CLPR. The present study, in which approximately half of the patients underwent a major hepatectomy and 60 per cent a PD, demonstrates that CLPR can be performed safely with low mortality and acceptable morbidity.…”

“…Hemming and co‐workers reported no operative deaths among 40 consecutive patients; however, the mean age of their patients was 53 years and no patient had a body mass index (BMI) greater than 27 kg/m 2 . Edwards and colleagues reported an increased morbidity rate after CLPR in patients with a preoperative BMI greater than 25 kg/m 2 and older than 60 years. The selection criteria used in the present study were not based on age or BMI, but rather on general medical conditions.…”

Is BMI associated with post‐operative complication risk among patients undergoing major abdominal surgery for cancer? A systematic review

“…12,[15][16][17][18][19][20][21] The remaining studies examined patients with pancreatic (n = 11), [104][105][106][107][108][109][110][111][112][113][114] hepatic (n = 10), [115][116][117][118][119][120][121][122][123][124] or a combination of various GI cancer types (n = 3). 8,125,126 The majority of publications were retrospective, singleinstitution analyses (n = 95; 80.5%) ( Table 2). Obesity status was considered as either a binary or categorical variable in nearly all studies, with a few studies (n = 9) examining obesity as a continuous variable.…”

“…Continued)65 all studies that reported BMI in three or more categories used established WHO categories to define the degree of obesity [8][9][10][11]19,29,34,37,43,45,48,52,56,60,62,63,68,70,72,75,79,83,90,100,[105][106][107]109,[114][115][116]123,125. …”