TY - JOUR
T1 - Pancreatoduodenectomy with colon resection for cancer: A nationwide retrospective analysis
AU - Marsman, E. Madelief
AU - de Rooij, Thijs
AU - van Eijck, Casper H.
AU - Boerma, Djamila
AU - Bonsing, Bert A.
AU - van Dam, Ronald M.
AU - van Dieren, Susan
AU - Erdmann, Joris I.
AU - Gerhards, Michael F.
AU - de Hingh, Ignace H.
AU - Kazemier, Geert
AU - Klaase, Joost
AU - Molenaar, I. Quintus
AU - Patijn, Gijs A.
AU - Scheepers, Joris J.
AU - Tanis, Pieter J.
AU - Busch, Olivier R.
AU - Besselink, Marc G.
PY - 2016/7
Y1 - 2016/7
N2 - Background. Microscopically radical (RO) resection of pancreatic, periampullary, or colon cancer may occasionally require a pancreatoduodenectomy with colon resection (PD-colon), but the benefits of this procedure have been disputed, and multicenter studies on morbidity and oncologic outcomes after PD-colon are lacking. This study aimed to assess complications and survival after PD-colon. Methods. Patients who had undergone PD-colon from 2004-2014 in 1 of 13 centers were analyzed retrospectively. Ninety-day morbidity was scored using the Clavien-Dindo score and the Comprehensive Complication Index (CCI, 0 = no complications, 100 = death). Survival was analyzed per histopathologic diagnosis. Results. After screening 3,218 consecutive PDs, 50 (1.6%) PD-colon patients (median age 66 years [interquartile range 55-72], 33 [66%] men) were included. Twenty-three (46%) patients had pancreatic ductal adenocarcinoma (PDAC), 19 (38%) other pathology, and 8 (16%) colon cancer. Ninety-day Clavien-Dindo >= 3 complications occurred in 30 (60%) patients without differences per diagnosis (P > .99); mean CCI was 39 (standard deviation 27). Colonic anastomosis leak, pancreatic fistula, and 90-day mortality occurred in 3 (6%), 2 (4%), and 4 (8%) patients, respectively. A total of 11/23 (48 %) patients with PDAC and 8/8 (100%) patients with colon cancer underwent an RO resection. Patients with PDAC had a median postoperative survival of 13 months (95 % confidence interval = 5-21). One-, 3-, and 5-year cumulative survival was 56 %, 21 %, and 14 %, respectively. Median survival after RO resection for PDAC was 21 months (95 % confidence interval = 6-35). All patients with colon cancer were alive at end of follow-up (median 24 months [95 % confidence interval = 9-110]). Conclusion. In this retrospective, multicenter study, PD-colon was associated with considerable complications and acceptable survival rates when a tumor negative resection margin was achieved.
AB - Background. Microscopically radical (RO) resection of pancreatic, periampullary, or colon cancer may occasionally require a pancreatoduodenectomy with colon resection (PD-colon), but the benefits of this procedure have been disputed, and multicenter studies on morbidity and oncologic outcomes after PD-colon are lacking. This study aimed to assess complications and survival after PD-colon. Methods. Patients who had undergone PD-colon from 2004-2014 in 1 of 13 centers were analyzed retrospectively. Ninety-day morbidity was scored using the Clavien-Dindo score and the Comprehensive Complication Index (CCI, 0 = no complications, 100 = death). Survival was analyzed per histopathologic diagnosis. Results. After screening 3,218 consecutive PDs, 50 (1.6%) PD-colon patients (median age 66 years [interquartile range 55-72], 33 [66%] men) were included. Twenty-three (46%) patients had pancreatic ductal adenocarcinoma (PDAC), 19 (38%) other pathology, and 8 (16%) colon cancer. Ninety-day Clavien-Dindo >= 3 complications occurred in 30 (60%) patients without differences per diagnosis (P > .99); mean CCI was 39 (standard deviation 27). Colonic anastomosis leak, pancreatic fistula, and 90-day mortality occurred in 3 (6%), 2 (4%), and 4 (8%) patients, respectively. A total of 11/23 (48 %) patients with PDAC and 8/8 (100%) patients with colon cancer underwent an RO resection. Patients with PDAC had a median postoperative survival of 13 months (95 % confidence interval = 5-21). One-, 3-, and 5-year cumulative survival was 56 %, 21 %, and 14 %, respectively. Median survival after RO resection for PDAC was 21 months (95 % confidence interval = 6-35). All patients with colon cancer were alive at end of follow-up (median 24 months [95 % confidence interval = 9-110]). Conclusion. In this retrospective, multicenter study, PD-colon was associated with considerable complications and acceptable survival rates when a tumor negative resection margin was achieved.
U2 - 10.1016/j.surg.2016.02.022
DO - 10.1016/j.surg.2016.02.022
M3 - Article
C2 - 27059639
SN - 0039-6060
VL - 160
SP - 145
EP - 152
JO - Surgery
JF - Surgery
IS - 1
ER -