Pancreaticoduodenectomy in multivisceral surgeries: clinical experience of two institutions
https://doi.org/10.16931/1995-5464.2024-4-107-114
Abstract
Aim. To describe the experience of multivisceral surgeries involving pancreaticoduodenectomy for tumors of various localizations, performed in two Russian medical institutions.
Materials and methods. A retrospective study was conducted on the outcomes of 251 multivisceral surgeries with pancreaticoduodenectomy performed in two medical institutions from January 2011 to April 2024.
Results. Tumors of pancreatic head, duodenum and large papilla of duodenum were detected in 180 cases (71.7%); colorectal tumors in 36 cases (14.3%); gastric tumors in 24 cases (9.6%); extrahepatic bile duct and gallbladder tumors in 7 cases (2.8%); renal tumors in 3 cases (1.2%); retroperitoneal tumor in 1 case (0.4%). In 107 cases, the surgery was combined with liver resection, including hemihepatectomy in 7 cases. Pancreaticoduodenectomy was combined with colorectal resection in 95 cases. Despite the extreme variability in the extent of multivisceral surgeries with pancreaticoduodenectomy, the complication rate and mortality amounted to 65.7% and 7.2%, respectively.
Conclusion. The structure of multivisceral surgeries with pancreaticoduodenectomy appears to be extremely heterogeneous in terms of localization, tumor histogenesis, and the volume of surgical interventions. The frequency of postoperative complications and mortality indicates acceptable tolerability of such surgeries.
About the Authors
V. I. EgorovRussian Federation
Vasiliy I. Egorov – Cand. of Sci. (Med.), Research Assistant, Department of Oncology, Radiation Diagnostics, and Radiation Therapy, Kazan State Medical University; Oncologist, Republican Clinical Oncology Dispensary; Applicant, Department of Abdominal Oncology No.2, N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of the Russian Federation.
23, Kashirskoe highway, Moscow, 115522; 49, Butlerov str., Kazan, 420012; 29, Sibirsky trakt, Kazan, 420029
A. G. Kotelnikov
Russian Federation
Aleksey G. Kotelnikov – Doct. of Sci. (Med.), Professor, Leading Researcher, Department of Abdominal Oncology No.2, N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Healthcare of the Russian Federation.
23, Kashirskoe highway, Moscow, 115522
Yu. I. Patyutko
Russian Federation
Yury I. Patyutko – Doct. of Sci. (Med.), Chief Scientific Consultant, Department of Abdominal Oncology No.2, N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Healthcare of the Russian Federation.
23, Kashirskoe highway, Moscow, 115522
D. V. Podluzhny
Russian Federation
Danil V. Podluzhny – Cand. of Sci. (Med.), Head of the Department of Abdominal Oncology No.2, N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Healthcare of the Russian Federation.
23, Kashirskoe highway, Moscow, 115522
F. Sh. Akhmetzyanov
Russian Federation
Foat Sh. Akhmetzyanov – Doct. of Sci. (Med.), Professor, Head of the Department of Oncology, Radiation Diagnostics and Radiation Therapy, Kazan State Medical University; Head of the Surgical Clinic of the Medical and Diagnostic Facility No. 2, Republican Clinical Oncology Dispensary.
49, Butlerov str., Kazan, 420012; 29, Sibirsky trakt, Kazan, 420029
D. M. Ruvinsky
Russian Federation
David M. Ruvinsky – Oncologist, Head of the Oncology Department No.11, Republican Clinical Oncology Dispensary.
29, Sibirsky trakt, Kazan, 420029
N. E. Kudashkin
Russian Federation
Nikolai E. Kudashkin – Cand. of Sci. (Med.), Senior Researcher, Department of Abdominal Oncology No.2, N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of the Russian Federation.
23, Kashirskoe highway, Moscow, 115522
A. N. Polyakov
Russian Federation
Alexandr N. Polyakov – Cand. of Sci. (Med.), Senior Researcher, Department of Abdominal Oncology No.2, N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Healthcare of the Russian Federation.
23, Kashirskoe highway, Moscow, 115522
D. M. Kantieva
Russian Federation
Dayana M. Kantieva – Oncologist, Drug Therapy Unit No. 2, N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Healthcare of the Russian Federation.
23, Kashirskoe highway, Moscow, 115522
I. S. Bazin
Russian Federation
Igor S. Bazin – Doct. of Sci. (Med.), Leading Researcher, Drug Therapy Unit No. 2, N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Healthcare of the Russian Federation.
23, Kashirskoe highway, Moscow, 115522
References
1. Pugalenthi A., Protic M., Gonen M., Kingham T.P., Angelica M.I., Dematteo R.P., Fong Y., Jarnagin W.R., Allen P.J. Postoperative complications and overall survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. J. Surg. Oncol. 2016; 113 (2): 188–193. https://doi.org/10.1002/jso.24125
2. Xiang C., Chen Y., Liu X., Zheng Z., Zhang H., Tan C. Prevention and treatment of grade C postoperative pancreatic fistula. J. Clin. Med. 2022; 11 (24): 7516. https://doi.org/10.3390/jcm11247516.
3. Akhaladze G.G., Goncharov S.V., Lagkueva I.D., Ragimov V.A., Dzhigkaeva M.M., Baliev Z.E. Pancreatoduodenectomy with the superior mesenteric vein resection without vascular reconstruction. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2022; 27 (3): 63–67. https://doi.org/10.16931/1995-5464.2022-3-63-67 (In Russian)
4. Li J., Liu Z., Xu X., Chen J. The role of vascular resection and reconstruction in pancreaticoduodenectomy. Asian J. Surg. 2024; 47 (1): 63–71. https://doi.org/10.1016/j.asjsur.2023.09.039
5. Patyutko Yu.I., Kudashkin N.E., Kotelnikov A.G. Surgical treatment of locally advanced right colon cancer. Oncological Coloproctology. 2014; 2: 28–32. https://doi.org/10.17650/2220-3478-2014-0-2-28-32 (In Russian)
6. Jin P., Liu H., Ma F.H., Ma S., Li Y., Xiong J.P., Kang W.Z., Hu H.T., Tian Y.T. Retrospective analysis of surgically treated pT4b gastric cancer with pancreatic head invasion. World J. Clin. Cases. 2021; 9 (29): 8718–8728. https://doi.org/10.12998/wjcc.v9.i29.8718
7. Li D.B., You J., Wang S.J., Zhou Y.M. Pancreaticoduodenectomy for locally advanced gastric cancer: results from a pooled analysis. Asian J. Surg. 2019; 42 (3): 477–481. https://doi.org/10.1016/j.asjsur.2018.09.005
8. Lehnert T., Methner M., Pollok A., Schaible A., Hinz U., Herfarth C. Multivisceral resection for locally advanced primary colon and rectal cancer: an analysis of prognostic factors in 201 patients. Ann. Surg. 2002; 235 (2): 217–225. https://doi.org/10.1097/00000658-200202000-00009
9. Chen J.B., Luo S.C., Chen C.C., Wu C.C., Yen Y., Chang C.H., Chen Y.A., P'eng F.K. Colo-pancreaticoduodenectomy for locally advanced colon carcinoma-feasibility in patients presenting with acute abdomen. World J. Emerg. Surg. 2021; 16 (1): 7. https://doi.org/10.1186/s13017-021-00351-6
10. Welch J.C., Gleeson E.M., Karachristos A., Pitt H.A. Hepatopancreatoduodenectomy in North America: are the outcomes acceptable? HPB (Oxford). 2020; 22 (3): 360–367. https://doi.org/10.1016/j.hpb.2019.08.010
11. Solaini L., de Rooij T., Marsman E.M., TeRiele W.W., Tanis P.J., van Gulik T.M., Gouma D.J., Bhayani N.H., Hackert T., Busch O.R., Besselink M.G. Pancreatoduodenectomy with colon resection for pancreatic cancer: a systematic review. HPB (Oxford). 2018; 20 (10): 881–887. https://doi.org/10.1016/j.hpb.2018.03.017
12. Yan X.L., Wang K., Bao Q., Wang H.W., Jin K.M., Wang J.Y., Xing B.C. En bloc right hemicolectomy with pancreatoduodenectomy for right-sided colon cancer invading duodenum. BMC Surg. 2021; 21 (1): 302. https://doi.org/10.1186/s12893-021-01286-0
13. Meng L., Huang Z., Liu J., Lai H., Zuo H., Liao J., Lin Y., Tang W., Mo X. En bloc resection of a T4B stage cancer of the hepatic flexure of the colon invading the liver, gall bladder, and pancreas/duodenum: a case report. Clin. Case Rep. 2020; 8 (12): 3524–3528. https://doi.org/10.1002/ccr3.3455
14. Cirocchi R., Partelli S., Castellani E., Renzi C., Parisi A., Noya G., Falconi M. Right hemicolectomy plus pancreaticoduodenectomy vs partial duodenectomy in treatment of locally advanced right colon cancer invading pancreas and/or only duodenum. Surg. Oncol. 2014; 23 (2): 92–98. https://doi.org/10.1016/j.suronc.2014.03.003
15. Cojocari N., Crihana G.V., Bacalbasa N., Balescu I., David L. Right-sided colon cancer with invasion of the duodenum or pancreas: a glimpse into our experience. Exp. Ther. Med. 2021; 22 (6): 1378. https://doi.org/10.3892/etm.2021.10813
16. Das B., Fehervari M., Hamrang-Yousefi S., Jiao L.R., Pai M., Jenkins J.T., Spalding DR.C. Pancreaticoduodenectomy with right hemicolectomy for advanced malignancy: a single UK hepatopancreaticobiliarycentre experience. Colorectal. Dis. 2023; 25 (1): 16–23. https://doi.org/10.1111/codi.16303
17. Roberts P., Seevaratnam R., Cardoso R., Law C., Helyer L., Coburn N. Systematic review of pancreaticoduodenectomy for locally advanced gastric cancer. Gastric. Cancer. 2012; 15 Suppl 1: S108–115. https://doi.org/10.1007/s10120-011-0086-5
18. Makuuchi R., Irino T., Tanizawa Y., Bando E., Kawamura T., Terashima M. Pancreaticoduodenectomy for gastric cancer. J. Cancer Metastasis Treat. 2018; 4: 26–35. http://dx.doi.org/10.20517/2394-4722.2018.15
19. Chang S.C., Tang C.M., Le P.H., Kuo C.J., Chen T.H., Wang S.Y., Chou W.C., Chen T.C., Yeh T.S., Hsu J.T. Impact of pancreatic resection on survival in locally advanced resectable gastric cancer. Cancers. 2021; 13 (6): 1289. https://doi.org/10.3390/cancers13061289
20. Tanaka M., Heckler M., Mihaljevic A.L., Sun H., Klaiber U., Heger U., Büchler M.W., Hackert T. CT response of primary tumor and CA19-9 predict resectability of metastasized pancreatic cancer after FOLFIRINOX. Eur. J. Surg. Oncol. 2019: 45 (8): 1453–1459. https://doi.org/10.1016/j.ejso.2019.03.039
21. De Simoni O., Scarpa M., Tonello M., Pilati P., Tolin F., Spolverato Y., Gruppo M. Oligometastatic pancreatic cancer to the liver in the era of neoadjuvant chemotherapy: which role for conversion surgery? A systematic review and meta-analysis. Cancers (Basel). 2020; 12 (11): 3402. https://doi.org/10.3390/cancers12113402
22. Zhou W., Wang D., Lou W. Current role of surgery in pancreatic cancer with synchronous liver metastasis. Cancer Control. 2020; 27 (1): 1073274820976593. https://doi.org/10.1177/1073274820976593
23. Mitsuka Y., Yamazaki S., Yoshida N., Yan M., Higaki T., Takayama T. Time interval-based indication for liver resection of metastasis from pancreatic cancer. World J. Surg. Oncol. 2020; 18 (1): 294. https://doi.org/10.1186/s12957-020-02058-5
24. Fong Z.V., Alvino D.M., Castillo C.F., Nipp R.D., Traeger L.N., Ruddy M., Lubitz C.C., Johnson C.D., Chang D.C., Warshaw A.L., Lillemoe K.D., Ferrone C.R. Health-related quality of life and functional outcomes in 5-year survivors after pancreaticoduodenectomy. Ann. Surg. 2017; 266 (4): 685–692. https://doi.org/10.1097/SLA.0000000000002380
25. Jung W., Kim H., Kwon W., Jang J.Y. Atrophy of remnant pancreas after pancreatoduodenectomy: risk factors and effects on quality of life, nutritional status, and pancreatic function. J. Hepatobiliary Pancreat. Sci. 2022; 29 (2): 239–249. https://doi.org/10.1002/jhbp.949
Supplementary files
Review
For citations:
Egorov V.I., Kotelnikov A.G., Patyutko Yu.I., Podluzhny D.V., Akhmetzyanov F.Sh., Ruvinsky D.M., Kudashkin N.E., Polyakov A.N., Kantieva D.M., Bazin I.S. Pancreaticoduodenectomy in multivisceral surgeries: clinical experience of two institutions. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2024;29(4):107-114. (In Russ.) https://doi.org/10.16931/1995-5464.2024-4-107-114