Indication for en bloc pancreatectomy with colectomy: when is it safe?

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Clinical Outcomes Research

Background:

• Aggressive resection of adjacent organs is often required for pancreatic or colonic lesions.
• The necessity and safety of simultaneous pancreatectomy with colectomy (P+C) remain debated due to potential increases in morbidity and mortality (MM).

Purpose of the Study:

• To investigate the impact of simultaneous pancreatectomy with colectomy (P+C) on patient morbidity and mortality (MM).
• To identify risk factors associated with increased MM in patients undergoing P+C.

Main Methods:

• A prospective collection of patients undergoing pancreatectomy (P) or P+C from 2006-2015 at a high-volume center.
• Exclusion of patients with additional multivisceral or enucleation procedures.
• Augmentation of data to 90-day outcomes using institutional databases and ACS-NSQIP.

Main Results:

• P+C accounted for 2.39% of pancreatectomies, with 43 patients included.
• Both 30-day and 90-day MM were significantly higher in the P+C group compared to the P-only group.
• Logistical regression identified colectomy as an independent risk factor for 90-day mortality (OR=3.556, p=0.013).

Conclusions:

• Simultaneous pancreatectomy with colectomy substantially increases patient morbidity and mortality.
• The type of pancreatectomy, lesion origin, or planning status did not mitigate the increased risk.
• Colectomy is an independent risk factor for mortality, necessitating informed patient consent regarding heightened postoperative risks.