Re-Operative Pancreaticoduodenectomy: Challenges and Outcomes

Manish S. Bhandare, Nikhil Mehta, Vikram Chaudhari, Naveena An Kumar, Esha Pai, Mahesh Goel, Shailesh V. Shrikhande

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Tata Memorial Centre (TMC) is a high-volume centre for pancreatic tumour resections. We found a continually increasing referral of pancreatic tumours for re-evaluation for surgery, after an initial unsuccessful attempt at resection. Aim: To evaluate reasons of initial in-operability, the feasibility of re-operative pancreatico-duodenectomy (R-PD) and short- and long-term outcomes after R-PD. Methods: Data was collected from a prospective database of GI and hepato-pancreato-biliary service, TMC, Mumbai from January 2008 to December 2016. Results: Forty patients with periampullary/pancreatic head tumours were referred to us after exploration. Thirty were planned for re-exploration, of whom 25 patients underwent successful R-PD, either upfront (n = 12) or after neo-adjuvant therapy (n = 13). Twenty were adenocarcinomas, 5 had other histologies. Majority of the patients were deemed inoperable in view of suspected vascular involvement at the time of initial surgery (68%). R0 resection was achieved in 90% of adenocarcinoma cases (n = 18). Postoperative major morbidity was 20% and mortality was 4% (n = 1). The estimated 1-, 2- and 5-year survival for those with adenocarcinoma was 83, 71.2, and 29.9% respectively. Conclusion: R-PD is safe and should be performed in experienced centres and can achieve long-term outcomes, comparable to conventional PD. The most common reason for denying resection at initial surgery was suspected or perceived vascular involvement.

Original languageEnglish
Pages (from-to)302-308
Number of pages7
JournalDigestive Surgery
Volume36
Issue number4
DOIs
Publication statusPublished - 01-06-2019

All Science Journal Classification (ASJC) codes

  • Surgery
  • Gastroenterology

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