Distal pancreatectomy with celiac axis resection: what are the added risks?

Abstract Background Reported series of a distal pancreatectomy with celiac axis resection (DP‐CAR) are either small or not adequately controlled. The aim of this analysis was to report a multicentre series of modified Appleby procedures with a comparison group to determine the relative operative ris...

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Published in:HPB (Oxford, England) England), 2015-09, Vol.17 (9), p.777-784
Main Authors: Beane, Joal D, House, Michael G, Pitt, Susan C, Molly Kilbane, E, Hall, Bruce L, Parmar, Abishek D, Riall, Taylor S, Pitt, Henry A
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Celiac Plexus - surgery
Female
Follow-Up Studies
Gastroenterology and Hepatology
Humans
Incidence
Male
Middle Aged
Neoplasm Staging
Original
Pancreatectomy - methods
Pancreatic Neoplasms - mortality
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - surgery
Postoperative Complications - epidemiology
Prospective Studies
Survival Rate - trends
Treatment Outcome
United States - epidemiology
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container_title HPB (Oxford, England)
container_volume 17
creator Beane, Joal D
House, Michael G
Pitt, Susan C
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Parmar, Abishek D
Riall, Taylor S
Pitt, Henry A
description Abstract Background Reported series of a distal pancreatectomy with celiac axis resection (DP‐CAR) are either small or not adequately controlled. The aim of this analysis was to report a multicentre series of modified Appleby procedures with a comparison group to determine the relative operative risk. Methods Data were gathered through the American College of Surgeons‐National Surgical Quality Improvement Program (ACS‐NSQIP) Pancreatectomy Demonstration Project. Over 14 months, 822 patients underwent a distal pancreatectomy at 43 institutions. Twenty of these patients (2.4%) also underwent a celiac axis resection. DP‐CAR patients were matched by age, gender, BMI, serum albumin, ASA class, gland texture, duct size and pathology to 172 patients undergoing DP alone. Results The majority of DP and DP‐CAR patients had adenocarcinomas (61% and 60%). The median operative time for a DP alone was shorter than for a DP‐CAR (207 versus 276 min, P < 0.01). Post‐operative acute kidney injury (1% versus 10%, P  
doi_str_mv 10.1111/hpb.12453
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The aim of this analysis was to report a multicentre series of modified Appleby procedures with a comparison group to determine the relative operative risk. Methods Data were gathered through the American College of Surgeons‐National Surgical Quality Improvement Program (ACS‐NSQIP) Pancreatectomy Demonstration Project. Over 14 months, 822 patients underwent a distal pancreatectomy at 43 institutions. Twenty of these patients (2.4%) also underwent a celiac axis resection. DP‐CAR patients were matched by age, gender, BMI, serum albumin, ASA class, gland texture, duct size and pathology to 172 patients undergoing DP alone. Results The majority of DP and DP‐CAR patients had adenocarcinomas (61% and 60%). The median operative time for a DP alone was shorter than for a DP‐CAR (207 versus 276 min, P &lt; 0.01). Post‐operative acute kidney injury (1% versus 10%, P  &lt; 0.03) and 30‐day mortality were higher after a DP‐CAR (1% versus 10%, P  &lt; 0.03). Conclusion A distal pancreatectomy with celiac axis resection is associated with increased operative time, post‐operative acute kidney injury and a 10% operative mortality. The decision to offer a modified Appleby procedure for a body of pancreas tumour should be made with full disclosure of the increased risks.</description><identifier>ISSN: 1365-182X</identifier><identifier>EISSN: 1477-2574</identifier><identifier>DOI: 10.1111/hpb.12453</identifier><identifier>PMID: 26201994</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Celiac Plexus - surgery ; Female ; Follow-Up Studies ; Gastroenterology and Hepatology ; Humans ; Incidence ; Male ; Middle Aged ; Neoplasm Staging ; Original ; Pancreatectomy - methods ; Pancreatic Neoplasms - mortality ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - surgery ; Postoperative Complications - epidemiology ; Prospective Studies ; Survival Rate - trends ; Treatment Outcome ; United States - epidemiology</subject><ispartof>HPB (Oxford, England), 2015-09, Vol.17 (9), p.777-784</ispartof><rights>International Hepato-Pancreato-Biliary Association</rights><rights>2015 International Hepato-Pancreato-Biliary Association</rights><rights>2015 International Hepato‐Pancreato‐Biliary Association</rights><rights>2015 International Hepato-Pancreato-Biliary Association.</rights><rights>Copyright © 2015 International Hepato-Pancreato-Biliary Association</rights><rights>2015 International Hepato-Pancreato-Biliary Association 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c6123-d5a1e5bb79491caf5d92cf49c2f296fe92f9e746dd0e1f8d25b99555eb0ad7f13</citedby><cites>FETCH-LOGICAL-c6123-d5a1e5bb79491caf5d92cf49c2f296fe92f9e746dd0e1f8d25b99555eb0ad7f13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557651/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557651/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,725,778,782,883,27907,27908,53774,53776</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26201994$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Beane, Joal D</creatorcontrib><creatorcontrib>House, Michael G</creatorcontrib><creatorcontrib>Pitt, Susan C</creatorcontrib><creatorcontrib>Molly Kilbane, E</creatorcontrib><creatorcontrib>Hall, Bruce L</creatorcontrib><creatorcontrib>Parmar, Abishek D</creatorcontrib><creatorcontrib>Riall, Taylor S</creatorcontrib><creatorcontrib>Pitt, Henry A</creatorcontrib><title>Distal pancreatectomy with celiac axis resection: what are the added risks?</title><title>HPB (Oxford, England)</title><addtitle>HPB (Oxford)</addtitle><description>Abstract Background Reported series of a distal pancreatectomy with celiac axis resection (DP‐CAR) are either small or not adequately controlled. The aim of this analysis was to report a multicentre series of modified Appleby procedures with a comparison group to determine the relative operative risk. Methods Data were gathered through the American College of Surgeons‐National Surgical Quality Improvement Program (ACS‐NSQIP) Pancreatectomy Demonstration Project. Over 14 months, 822 patients underwent a distal pancreatectomy at 43 institutions. Twenty of these patients (2.4%) also underwent a celiac axis resection. DP‐CAR patients were matched by age, gender, BMI, serum albumin, ASA class, gland texture, duct size and pathology to 172 patients undergoing DP alone. Results The majority of DP and DP‐CAR patients had adenocarcinomas (61% and 60%). The median operative time for a DP alone was shorter than for a DP‐CAR (207 versus 276 min, P &lt; 0.01). Post‐operative acute kidney injury (1% versus 10%, P  &lt; 0.03) and 30‐day mortality were higher after a DP‐CAR (1% versus 10%, P  &lt; 0.03). Conclusion A distal pancreatectomy with celiac axis resection is associated with increased operative time, post‐operative acute kidney injury and a 10% operative mortality. The decision to offer a modified Appleby procedure for a body of pancreas tumour should be made with full disclosure of the increased risks.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Celiac Plexus - surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastroenterology and Hepatology</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm Staging</subject><subject>Original</subject><subject>Pancreatectomy - methods</subject><subject>Pancreatic Neoplasms - mortality</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Postoperative Complications - epidemiology</subject><subject>Prospective Studies</subject><subject>Survival Rate - trends</subject><subject>Treatment Outcome</subject><subject>United States - epidemiology</subject><issn>1365-182X</issn><issn>1477-2574</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNp1kt9PFDEQxxujEUQf_AdME1_kYaE_d68-YABBjCSaqIlvTbeduoW97dHucd5_b9cDVKJ96STzmW9m5jsIPadkj5a33y3aPcqE5A_QNhVNUzHZiIcl5rWs6Ix920JPcr4ghFFC1WO0xWpWAiW20Ye3IY-mxwsz2ARmBDvG-RqvwthhC30wFpsfIeMEuaRCHF7jVWdGbBLgsQNsnAOHU8iX-c1T9MibPsOzm38HfT09-XJ8Vp1_fPf--PC8sjVlvHLSUJBt2yihqDVeOsWsF8oyz1TtQTGvoBG1cwSonzkmW6WklNAS4xpP-Q462Ogulu0cnIVhTKbXixTmJq11NEH_nRlCp7_Hay2kbGo5Cby6EUjxagl51POQy7S9GSAus6YNkYQoRXhBX95DL-IyDWW8iRJsxngtCrW7oWyKOSfwd81QoieLdLFI_7KosC_-7P6OvPWkAPsbYBV6WP9fSZ99OrqV5JsKKFu_DpB0tgEGCy6k4pp2MfyzkYN7VbYPQ7Cmv4Q15N9z6sw00Z-na5qOiUpOKS8KPwEDnsHt</recordid><startdate>201509</startdate><enddate>201509</enddate><creator>Beane, Joal D</creator><creator>House, Michael G</creator><creator>Pitt, Susan C</creator><creator>Molly Kilbane, E</creator><creator>Hall, Bruce L</creator><creator>Parmar, Abishek D</creator><creator>Riall, Taylor S</creator><creator>Pitt, Henry A</creator><general>Elsevier Ltd</general><general>Wiley Subscription Services, Inc</general><general>John Wiley &amp; 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Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>HPB (Oxford, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Beane, Joal D</au><au>House, Michael G</au><au>Pitt, Susan C</au><au>Molly Kilbane, E</au><au>Hall, Bruce L</au><au>Parmar, Abishek D</au><au>Riall, Taylor S</au><au>Pitt, Henry A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Distal pancreatectomy with celiac axis resection: what are the added risks?</atitle><jtitle>HPB (Oxford, England)</jtitle><addtitle>HPB (Oxford)</addtitle><date>2015-09</date><risdate>2015</risdate><volume>17</volume><issue>9</issue><spage>777</spage><epage>784</epage><pages>777-784</pages><issn>1365-182X</issn><eissn>1477-2574</eissn><abstract>Abstract Background Reported series of a distal pancreatectomy with celiac axis resection (DP‐CAR) are either small or not adequately controlled. The aim of this analysis was to report a multicentre series of modified Appleby procedures with a comparison group to determine the relative operative risk. Methods Data were gathered through the American College of Surgeons‐National Surgical Quality Improvement Program (ACS‐NSQIP) Pancreatectomy Demonstration Project. Over 14 months, 822 patients underwent a distal pancreatectomy at 43 institutions. Twenty of these patients (2.4%) also underwent a celiac axis resection. DP‐CAR patients were matched by age, gender, BMI, serum albumin, ASA class, gland texture, duct size and pathology to 172 patients undergoing DP alone. Results The majority of DP and DP‐CAR patients had adenocarcinomas (61% and 60%). The median operative time for a DP alone was shorter than for a DP‐CAR (207 versus 276 min, P &lt; 0.01). Post‐operative acute kidney injury (1% versus 10%, P  &lt; 0.03) and 30‐day mortality were higher after a DP‐CAR (1% versus 10%, P  &lt; 0.03). Conclusion A distal pancreatectomy with celiac axis resection is associated with increased operative time, post‐operative acute kidney injury and a 10% operative mortality. The decision to offer a modified Appleby procedure for a body of pancreas tumour should be made with full disclosure of the increased risks.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>26201994</pmid><doi>10.1111/hpb.12453</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record>
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subjects Adult
Aged
Aged, 80 and over
Celiac Plexus - surgery
Female
Follow-Up Studies
Gastroenterology and Hepatology
Humans
Incidence
Male
Middle Aged
Neoplasm Staging
Original
Pancreatectomy - methods
Pancreatic Neoplasms - mortality
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - surgery
Postoperative Complications - epidemiology
Prospective Studies
Survival Rate - trends
Treatment Outcome
United States - epidemiology
title Distal pancreatectomy with celiac axis resection: what are the added risks?
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