Extended Whipple's PD including vascular and visceral resections; short and long-term outcomes

Introduction: The utility of vascular (VR) and extended visceral resection (ER) along with Whipple's PD remains a subject of controversy. We aimed to examine our long and short term outcomes in this group of patients. Methods: We utilised a prospectively maintained database of all patients who underwent PD in an 11 year period from Jan 2002 to Dec 2013. Data were analysed using Statview Ltd programme. Results: Some 503 patients underwent PD. Of these, 50 (10%) had extended resections in the form of vascular resection (25; 50%), 25 (50%) extended visceral resection. Of these, 24 patients experienced post-operative complications 10 of which required surgical re-exploration. The median LoS was 14 days (IQR 11–20). Some 25 patients had PDAC, 8 had peri-ampullary tumours, 5 had colorectal tumours and 5 had pNET. In the PDAC group, there was no significant difference in overall survival between those undergoing VR or ER (p = 0.8), however, the ER had an improved overall survival compared to VR in non PDAC patients (p = 0.02). The 5-yr survival for the PDAC ER/VR group was 21.3% compared to 27.6% for the PDAC group undergoing standard PD. The overall in- hospital mortality was 3(6%); 8% for VR and 4% for ER), which was significantly higher than for the remainder of the PD group (3/453 = 0.7%, p = 0.002). Conclusions: The long-term outcome of extended vascular or organ resection in PDAC are comparable with the standard resection. However, a higher post operative mortality should be borne in mind when considering these patients for VR/ER.