Morbidity of colectomy during pancreatoduodenectomy: An analysis of the pancreas‐targeted American College of Surgeons National Surgical Quality Improvement Program Registry

Abstract

Background Pancreatoduodenectomy is a complex operation with considerable morbidity and mortality. Locally advanced tumors may require concurrent colectomy. We hypothesized that a concurrent colectomy increases the risk associated with pancreatoduodenectomy. Methods This retrospective review of the 2014–2019 pancreas‐targeted American College of Surgeons National Surgical Quality Improvement Program registry classified operations as pancreatoduodenectomy (PD) versus pancreatoduodenectomy/colectomy (PD+C). The two groups were compared with respect to demographics, comorbidities, disease characteristics, intraoperative variables, and postoperative outcomes. Main effect models were developed to examine the effect of concurrent colectomy on outcomes after adjusting for potential confounders. Results Of 24 421 pancreatoduodenectomies, 430 (1.8%) involved concurrent colectomy. PD + C patients had less comorbidities (obesity 19% vs. 27%, hypertension 43% vs. 53%, diabetes 20% vs. 26%) and were associated with malignant diagnosis (94% vs. 83%), vascular resection (28% vs. 18%), and longer operative time (median 6.9 vs. 6 h). On multivariable analysis, concurrent colectomy was independently associated with serious morbidity (adjusted odds ratio [OR] 2.62, 95% confidence interval [CI]: 1.94–3.54) but not mortality (OR 1.44 [0.63–3.31]). Conclusions Concurrent colectomy at the time of pancreatoduodenectomy significantly increased the odds of serious morbidity but did not affect mortality. This should be considered in operative planning, preoperative counseling, and sequencing of cancer‐directed treatments.

Pancreaticoduodenectomies with Concurrent Colectomies: Indications, Technical Issues, Complications, and Oncological Outcomes

“…Other studies from single high-volume centers showed the association of colectomies with PD in 4.4 to 11.5% of patients [28][29][30]. A segmental or right colectomy is the most common type associated with PD [25][26][27].…”

“…As mentioned above, the association of PD with colectomies is an uncommon surgical procedure in clinical practice. Studies including 3275 to 24,421 PDs each showed that a concurrent colectomy was required in only 1.4-2% of the patients [12,[25][26][27]. Other studies from single high-volume centers showed the association of colectomies with PD in 4.4 to 11.5% of patients [28][29][30].…”

“…The main indication in the most extensive series of patients with PD and concurrent colectomies was periampullary malignancies, with PDAC as a leading indication [12,14,[26][27][28][29][30][31]. However, many single-center studies providing early and/or late outcomes after PD with concurrent colectomies for PDAC/other periampullary malignancies include a minimal number of patients [28,29,32]; only a few single-center studies include at least ten patient outcomes [14,30,33].…”

“…However, many single-center studies providing early and/or late outcomes after PD with concurrent colectomies for PDAC/other periampullary malignancies include a minimal number of patients [28,29,32]; only a few single-center studies include at least ten patient outcomes [14,30,33]. Few other studies review the outcomes from previously published series or multicentric national databases [12,26,27,31,34]. Nevertheless, about 181 PD patients with concurrent colectomies for PDAC were described in the literature till 2017 [34].…”

“…In a US national study, the most significant published to date, presenting the indication and outcomes of 430 patients with PD and concurrent colectomies, pancreatic, ampullary, and duodenal malignancies represented 70.8% of patients, while among patients with colon cancers, they were only 6.2%; other indications included neuroendocrine tumors (5.8%) and benign pathologies (16.8%) [27]. In a Dutch national study of 50 patients with PD and concurrent colectomies, the two main indications were PDAC (46%) and colon cancer (16%) [26].…”