Postoperative outcomes and their risk factors in left pancreatectomy with and without multivisceral resection

The aim of the present study was to identify risk factors associated with postoperative morbidity and mortality in patients undergoing isolated left pancreatectomy and those undergoing left pancreatic resection as part of a multivisceral resection. We performed a retrospective analysis of 296 adult patients who underwent elective left pancreatectomy from 2005 to 2022 at the University Hospital Erlangen. Patient demographics, pre- and intraoperative findings, along with postoperative outcomes, were collected and tested as predictive factors for various short-term postoperative parameters. Isolated left pancreatectomy (LP) was performed in 173 patients, while 123 patients underwent left pancreatectomy as part of a multivisceral resection (multivisceral LP). Multivisceral LP was associated with a higher rate of major morbidity (27% vs. 17%, p = 0.043) and mortality (7% vs. 2%, p = 0.046) compared to LP. Independent risk factors for major morbidity included the need for intraoperative blood transfusion and oncological lymphadenectomy in the LP group and longer operative time in the multivisceral LP group. CR-POPF was associated with the indication for surgery in the LP group. Independent risk factors for re-surgery included intraoperative blood transfusion in the LP group and ASA III or IV in the multivisceral LP group. Cardiovascular diseases were associated with higher mortality in the LP group, while COPD was the only risk factor for mortality in the multivisceral LP group. Multivisceral left pancreatectomy is associated with worse outcomes compared to isolated left pancreatectomy. In both groups, relevant risk factors predict postoperative complications. Patients with these identified risk factors should receive close monitoring during the postoperative course to anticipate outcomes with an increased risk of complications.