Combining Liver and Pancreatic Resections Is Safe

Combined liver and pancreatic resection (CLPR) is safe and can be performed with fairly low morbidity and mortality rates, according to a new study.

Researchers at the University of Strasbourg (France) conducted a review of two prospectively maintained databases for pancreatic and liver resections to identify patients who underwent CLPR between January 1994 and January 2012. The researchers then examined the clinical, pathological, and surgical outcomes and analyzed postoperative morbidity results. In all, 50 consecutive patients with a median age of 58 years underwent CLPR. Indications for surgery included neuroendocrine carcinoma (16 patients), biliary cancer (15), colonic cancer (5), duodenal cancer (1), and others (13).

The type of pancreatic resection included pancreaticoduodenectomy (30), distal pancreatectomy (17), spleen-preserving distal pancreatectomy (2) and total pancreatectomy (1). Twenty-three patients had associated major hepatectomies, 27 underwent minor liver resections, and 11 had associated vascular resections. The analysis showed no differences in postoperative morbidity in relation to extent of liver resection or type of pancreatic resection. The use of preoperative chemotherapy was the only independent risk factor associated with postoperative morbidity. The study was published on April 4, 2014, in the British Journal of Surgery.

“In Western countries, combined liver and pancreatic resections are performed rarely because of the perceived high morbidity and mortality rates,” said lead author Pietro Addeo, MD, of the University of Strasbourg Hôpital de Hautepierre-Hôpitaux, adding that the new study showed that “CLPR can be performed with fairly low morbidity and mortality rates. Patients receiving chemotherapy should be evaluated carefully before surgery is considered.”

Combined resection of both the liver and pancreas remains a controversial procedure. For many, the need for such an extended procedure implies a scope of disease spread that is usually not amenable to surgical control, and the extent of the procedure exposes the patients to substantial operative risks.

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