Morbidity of Left Pancreatectomy when Associated with Multivisceral Resection for Abdominal Mesenchymal Neoplasms

摘要

Context Resection of adjacent visceralorgans is often required in surgery for abdominal mesenchymal tumors. ObjectivesTo analyze the specific perioperative morbidity and mortality of a leftpancreatectomy in multivisceral resections for mesenchymal tumors. PatientsThis paper considered all patients treated at National Cancer Institute, Milan,Italy, from January 1997 to May 2009 for the resection of abdominal mesenchymalneoplasms requiring a concomitant left pancreatectomy. The extension ofsurgery, pathology of both the tumor and the pancreatic tissue, completeness ofresection, administration of pre or postoperative treatments and postoperativeoutcome were analyzed. The overall survival of the entire population was alsoassessed. Results Fifty-seven patients affected by localized leftretroperitoneal mesenchymal neoplasms or intra-abdominal gastrointestinalstromal tumors were identified. A macroscopically complete resection wasachieved in all but 3 patients (5.3%) and the neoplastic involvement ofpancreatic tissue was documented at pathology in 26 (45.6%) patients. Surgical postoperativecomplications occurred in 20 patients (35.1%); 7 patients (12.3%) developed a postoperativepancreatic fistula. With a median follow-up of the surviving patients of 32months (interquartile range: 20-57 months), the overall survival at 5 years was 67.0%. Conclusion Left pancreatic resection seemed to be a safeprocedure, even when it is part of a multivisceral resection for abdominal mesenchymalneoplasms. When margins are crucial for cure, the left pancreas should thenalways be resected, independently of its direct infiltration.