Outcomes after extended pancreatectomy in patients with borderline resectable and locally advanced pancreatic cancer

Abstract

Extended resections are associated with increased perioperative morbidity and mortality, particularly when extended total pancreatectomy is performed. Favourable long-term outcome is achieved in some patients.

Short-Term Outcomes of Extended Pancreatectomy: A Single-Surgeon Experience

“…In their study however, patients with additional portal vein resection or splenectomy that was not done in the context of DP or TP were not considered as having undergone multivisceral resection, although they were included in the analysis of morbidity and mortality. In their more recent study of over 1,800 patients who underwent pancreatectomy for borderline resectable tumors, Hartwig et al [10] found significantly increased rates of delayed gastric emptying, re-laparotomy, and mortality in patients who underwent EP. With respect to DP, multivisceral resection has also been found to increase the odds of overall morbidity [26,27].…”

“…The first, a large retrospective study from Heidelberg, examined 611 EP patients compared to 1,217 patients who underwent standard pancreatectomy (SP) over a period of about 12 years. Analysis revealed EP patients to suffer from significantly more morbidity and mortality compared to SP patients [10]. In the second study, De Reuver et al [11] studied 111 EPs and 66 SPs, but found no difference in mortality and morbidity between them.…”

“…Recognizing these limitations and the need for a uniform definition, the International Study Group of Pancreatic Surgery (ISGPS) in 2014 published a consensus paper to standardize the definition of EP [9]. Since then, there have been only two studies reporting on the outcomes of EP according to this definition [10,11]. The first, a large retrospective study from Heidelberg, examined 611 EP patients compared to 1,217 patients who underwent standard pancreatectomy (SP) over a period of about 12 years.…”

“…In the second study, De Reuver et al [11] studied 111 EPs and 66 SPs, but found no difference in mortality and morbidity between them. It is important to note that both studies were based on a multisurgeon experience [10], which may have resulted in biases which can confound results.…”

Onco-surgical Strategies in Pancreatic Ductal Adenocarcinoma

“…Currently there are two approaches to a borderline PDAC: upfront surgery and neoadjuvant therapy followed by resection. Some surgical teams prefer upfront surgery for borderline resectable PDAC (42,58,59). Furthermore, the International Study Group for Pancreatic Surgery does not recommend routine neoadjuvant therapy for patients with PDAC and venous invasion where resection and reconstruction is feasible (39).…”