Pancreatoduodenectomy with colon resection for cancer: A nationwide retrospective analysis

E. Madelief Marsman; Thijs de Rooij; Casper H. van Eijck; Djamila Boerma; Bert A. Bonsing; Ronald M. van Dam; Susan van Dieren; Joris I. Erdmann; Michael F. Gerhards; Ignace H. de Hingh; Geert Kazemier; Joost Klaase; I. Quintus Molenaar; Gijs A. Patijn; Joris J. Scheepers; Pieter J. Tanis; Olivier R. Busch; Marc G. Besselink

doi:10.1016/j.surg.2016.02.022

Pancreatoduodenectomy with colon resection for cancer: A nationwide retrospective analysis

E. Madelief Marsman
, Thijs de Rooij
, Casper H. van Eijck
, Djamila Boerma
, Bert A. Bonsing
, Ronald M. van Dam
, Susan van Dieren
, Joris I. Erdmann
, Michael F. Gerhards
, Ignace H. de Hingh
, Geert Kazemier
, Joost Klaase
, I. Quintus Molenaar
, Gijs A. Patijn
, Joris J. Scheepers
, Pieter J. Tanis
, Olivier R. Busch
, Marc G. Besselink^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

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.

Original language	English
Pages (from-to)	145-152
Number of pages	8
Journal	Surgery
Volume	160
Issue number	1
DOIs	https://doi.org/10.1016/j.surg.2016.02.022
Publication status	Published - Jul 2016

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10.1016/j.surg.2016.02.022

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Marsman, E. M., de Rooij, T., van Eijck, C. H., Boerma, D., Bonsing, B. A., van Dam, R. M., van Dieren, S., Erdmann, J. I., Gerhards, M. F., de Hingh, I. H., Kazemier, G., Klaase, J., Molenaar, I. Q., Patijn, G. A., Scheepers, J. J., Tanis, P. J., Busch, O. R., & Besselink, M. G. (2016). Pancreatoduodenectomy with colon resection for cancer: A nationwide retrospective analysis. Surgery, 160(1), 145-152. https://doi.org/10.1016/j.surg.2016.02.022

@article{be847c1e9bab47c7bbc9aae03a233712,

title = "Pancreatoduodenectomy with colon resection for cancer: A nationwide retrospective analysis",

abstract = "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.",

author = "Marsman, \{E. Madelief\} and \{de Rooij\}, Thijs and \{van Eijck\}, \{Casper H.\} and Djamila Boerma and Bonsing, \{Bert A.\} and \{van Dam\}, \{Ronald M.\} and \{van Dieren\}, Susan and Erdmann, \{Joris I.\} and Gerhards, \{Michael F.\} and \{de Hingh\}, \{Ignace H.\} and Geert Kazemier and Joost Klaase and Molenaar, \{I. Quintus\} and Patijn, \{Gijs A.\} and Scheepers, \{Joris J.\} and Tanis, \{Pieter J.\} and Busch, \{Olivier R.\} and Besselink, \{Marc G.\}",

year = "2016",

month = jul,

doi = "10.1016/j.surg.2016.02.022",

language = "English",

volume = "160",

pages = "145--152",

journal = "Surgery",

issn = "0039-6060",

publisher = "Elsevier Inc.",

number = "1",

}

Marsman, EM, de Rooij, T, van Eijck, CH, Boerma, D, Bonsing, BA, van Dam, RM, van Dieren, S, Erdmann, JI, Gerhards, MF, de Hingh, IH, Kazemier, G, Klaase, J, Molenaar, IQ, Patijn, GA, Scheepers, JJ, Tanis, PJ, Busch, OR & Besselink, MG 2016, 'Pancreatoduodenectomy with colon resection for cancer: A nationwide retrospective analysis', Surgery, vol. 160, no. 1, pp. 145-152. https://doi.org/10.1016/j.surg.2016.02.022

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 -

Pancreatoduodenectomy with colon resection for cancer: A nationwide retrospective analysis

Abstract

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