Postoperative outcomes of pancreatoduodenaectomy with colon resection

AIM: to assess early results of pancreatoduodenalectomy with colon resection for cancer.
PATIENTS AND METHODS: a retrospective cohort two-center controlled study included 927 patients. The first group included 95 patients after рancreatoduodenalectomy with colon resection. The second group included 832 patients who underwent рancreatoduodenalectomy without resection of adjacent organs. The first group was divided into two subgroups: the first subgroup is patients with malignant neoplasms of the colon — 42, the second subgroup is patients with malignant neoplasms of other sites — 53.
RESULTS: the group of patients with рancreatoduodenalectomy and colon resection was significantly more often assessed according to the ECOG 2–3 and ASA 3 (52/95 (54.7%) vs 63/669 (9.4%), p < 0.001 and 25/95 (26.3%) vs 104/669 (15.5%), respectively). The postoperative morbidity rate, as well as their class according to Clavien-Dindo, was homogeneous in both groups. The postoperative mortality rate was higher in the group of рancreatoduodenalectomy with colon resection (13/42 (31.0%) vs 49/832 (5.9%), p = 0.004). When comparing with subgroups, the postoperative mortality rate was comparable between patients after рancreatoduodenalectomy with colon resection for colon cancer and рancreatoduodenalectomy without resection of adjacent organs (3/42 (7.1%) vs 49 / 832 (5.9%), р = 0.7), and was significantly higher in the рancreatoduodenalectomy with colon resection (10/53 (18.9%) vs 49/832 (5,9%), р < 0.001).
CONCLUSION: patients in the рancreatoduodenalectomy with colon resection group are clinically more severe, and the operation itself is accompanied by a high rate of postoperative morbidity, but a comparable with рancreatoduodenalectomy in a standard volume, without resection of adjacent organs. Рancreatoduodenalectomy with colon resection for colon cancer is also associated with a comparable rate of postoperative mortality with standard рancreatoduodenalectomy, while рancreatoduodenalectomy with colon resection for cancer of other locations is characterized by a significantly higher level of postoperative mortality.

1. Pugalenthi A, Protic M, Gonen M, et al. Postoperative complications and overall survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. J Surg Oncol. 2016;113(2):188–93. doi: 10.1002/jso.24125

2. Simon R. Complications After Pancreaticoduodenectomy. Surg Clin North Am. 2021;101(5):865–874. doi: 10.1016/j.suc.2021.06.011

3. Kokkinakis S, Kritsotakis EI, Maliotis N, et al. Complications of modern pancreaticoduodenectomy: A systematic review and meta-analysis. Hepatobiliary Pancreat Dis Int. 2022;21(6):527–537. doi: 10.1016/j.hbpd.2022.04.006

4. Jin P, Liu H, Ma FH, et al. Retrospective analysis of surgically treated pT4b gastric cancer with pancreatic head invasion. World J Clin Cases. 2021;9(29):8718–8728. doi: 10.12998/wjcc.v9.i29.8718

5. Patyutko Yu.I., Kudashkin N.E., Kotelnikov A.G. Surgical treatment of locally advanced right colon cancer. Onkologičeskaâ koloproktologiâ. 2014;(2):28–32. (In Russ.). doi: 10.17650/2220-3478-2014-0-2-28-32

6. Yan XL, Wang K, Bao Q, et al. En bloc right hemicolectomy with pancreatoduodenectomy for right-sided colon cancer invading duodenum. BMC Surg. 2021;21(1):302. doi: 10.1186/s12893-021-01286-0

7. Solaini L, de Rooij T, Marsman EM, et al. Pancreatoduodenectomy with colon resection for pancreatic cancer: a systematic review. HPB (Oxford). 2018;20(10):881–887. doi: 10.1016/j.hpb.2018.03.017

8. Meng L, Huang Z, Liu J, et al. 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. doi: 10.1002/ccr3.3455

9. Cirocchi R, Partelli S, Castellani E, et al. 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):92–8. doi: 10.1016/j.suronc.2014.03.003

10. Cojocari N, Crihana GV, Bacalbasa N, et al. Right-sided colon cancer with invasion of the duodenum or pancreas: A glimpse into our experience. Exp Ther Med. 2021;22(6):1378. doi: 10.3892/etm.2021.10813

11. Das B, Fehervari M, Hamrang-Yousefi S, et al. Pancreaticoduodenectomy with right hemicolectomy for advanced malignancy: a single UK hepatopancreaticobiliary centre experience. Colorectal Dis. 2023;25(1):16–23. doi: 10.1111/codi.16303

12. Hogan J, Samaha G, Burke J, et al. Emergency presenting colon cancer is an independent predictor of adverse disease-free survival. Int Surg. 2015;100(1):77–86. doi: 10.9738/INTSURG-D-13-00281.1

13. Ocak S, Bük Ö, Çiftci A, et al. Comparison Of Emergency And Elective Colorectal Cancer Surgery- A Single Center Experience. Pol Przegl Chir. 2021;93(2):40–42. doi: 10.5604/01.3001.0014.8104

14. Chen JB, Luo SC, Chen CC, et al. Colo-pancreaticoduodenectomy for locally advanced colon carcinoma-feasibility in patients presenting with acute abdomen. World J Emerg Surg. 2021;16(1):7. doi: 10.1186/s13017-021-00351-6

15. Egorov V.I., Akhmetzyanov F.S., Kaulgud H.A., Ruvinskiy D.M. Clinical case of multivisceral en bloc resection for locally advanced cancer of the colon hepatic flexure. Kazan medical journal. 2024;105(4):669–676. (in Russ.). doi: 10.17816/KMJ628774

16. Hipp J, Rist L, Chikhladze S, et al. Perioperative risk of pancreatic head resection-nomogram-based prediction of severe postoperative complications as a decisional aid for clinical practice. Langenbecks Arch Surg. 2022;407(5):1935–1947. doi: 10.1007/s00423-021-02426-z

17. van Beek DJ, Takkenkamp TJ, Wong-Lun-Hing EM, et al. Risk factors for complications after surgery for pancreatic neuroendocrine tumors. Surgery. 2022;172(1):127–136. doi: 10.1016/j.surg.2022.02.007

18. Gosavi R, Chia C, Michael M, et al. Neoadjuvant chemotherapy in locally advanced colon cancer: a systematic review and metaanalysis. Int J Colorectal Dis. 2021;36(10):2063–2070. doi: 10.1007/s00384-021-03945-3

19. Nair KG, Kamath SD, Chowattukunnel N, et al. Preoperative Strategies for Locally Advanced Colon Cancer. Curr Treat Options Oncol. 2024;25(3):376–388. doi: 10.1007/s11864-024-01184-6

20. Zhang B, Yuan Q, Li S, et al. Risk factors of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: A systematic review and meta-analysis. Medicine (Baltimore). 2022;101(26):e29757. doi: 10.1097/MD.0000000000029757

21. Li B, Pu N, Chen Q, et al. Comprehensive Diagnostic Nomogram for Predicting Clinically Relevant Postoperative Pancreatic Fistula After Pancreatoduodenectomy. Front Oncol. 2021;11:717087. doi: 10.3389/fonc.2021.717087