Multivisceral surgery for ductal adenocarcinoma of the pancreatic head: early and long-term outcomes

Aim. To evaluate the early and long-term outcomes of multivisceral surgery for ductal adenocarcinoma of the pancreatic head.

Materials and methods. Group 1 (main group) included 63 patients who underwent multivisceral surgery for ductal adenocarcinoma of the pancreatic head. Group 2 (control group) consisted of 442 patients with ductal adenocarcinoma of the pancreatic head who underwent standard pancreatoduodenectomy. Patients with stage IV tumors were excluded.

Results. Immediate outcomes were comparable between the groups, except for a higher incidence of intra-abdominal abscesses in Group 1 (12.7% vs. 2.1%; p < 0.001). Postoperative mortality differed insignificantly (6.3% vs. 4.3%; p = 0.465). The median overall survival in Group 1 was 22 months compared to 33 months in Group 2, and the 5-year overall survival rates were 9.1% and 20.4%, respectively (p = 0.001). The frequency of adjuvant chemotherapy administration (p = 0.285) and the median number of chemotherapy cycles (p = 0.446) differed insignificantly between the groups. The 5-year overall survival among patients who received adjuvant chemotherapy was 13.3% in Group 1 and 19.4% in Group 2. The median overall survival in these groups was 30 and 35 months, respectively (p = 0.108). In Group 2, the median overall survival without neoadjuvant chemotherapy was 35 months, compared to 31 months with neoadjuvant chemotherapy (p = 0.411).

Conclusion. Multivisceral resections involving pancreatoduodenectomy for ductal adenocarcinoma of the pancreatic head are associated with comparable immediate outcomes to standard pancreatoduodenectomy without adjacent organ resection. These outcomes are comparable only when the procedures are performed in specialized centers and when adequate adjuvant chemotherapy is administered; without it, survival rates following multivisceral surgery were significantly lower. Indications for multivisceral procedures require a personalized approach that takes into account all prognostic factors.

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