Liver-directed therapy for hepatic metastases in patients undergoing pancreaticoduodenectomy: A dual-center analysis

Mechteld C. De Jong, Michael B. Farnell, Guido Sclabas, Steven C. Cunningham, John L. Cameron, Jean Francois Geschwind, Christopher L. Wolfgang, Joseph M. Herman, Barish H. Edil, Michael A. Choti, Richard D. Schulick, David M. Nagorney, Timothy M. Pawlik

Research output: Contribution to journalArticlepeer-review

56 Scopus citations

Abstract

Objectives: To analyze the perioperative and long-term outcomes of patients undergoing liver-directed therapy after pancreaticoduodenectomy in a large dual-center cohort of patients. Background: Although aggressive liver-directed therapy may be beneficial, liver-directed therapy may be associated with a high risk of complications after pancreaticoduodenectomy. Methods: Of 5025 patients who underwent pancreaticoduodenectomy at the Johns Hopkins Hospital and the Mayo Clinic between 1970 and 2008, 126 (2.5%), patients were identified who were also treated with either simultaneous or staged liver-directed therapy. Data on demographics, primary tumor, and hepatic metastasis characteristics, as well as details of the liver-directed therapy were collected and analyzed. Results: Primary tumor histology included neuroendocrine carcinoma (34.9%), pancreatic ductal adenocarcinoma (33.4%), distal cholangiocarcinoma (8.7%), ampullary carcinoma (7.1%), duodenal carcinoma (4.0%), or other (11.9%). Liver-directed therapies included hepatic resection alone (45.2%), hepatic resection plus ablation (11.1%), ablation alone (7.9%), transarterial chemoembolization (9.5%), and whole-liver irradiation (22.2%). The overall morbidity following liver-directed therapy was 34.1% and overall mortality was 2.4%. Patients undergoing staged liver-directed therapy (14.5%) versus simultaneous pancreaticoduodenectomy plus liver-directed therapy (7.0%) were more likely to develop a liver abscess (P < 0.05). Of those patients who developed complications, the majority (55.8%) were major (Clavien grade ≥3). Conclusions: Pancreaticoduodenectomy plus liver-directed therapy is associated with considerable morbidity. The incidence of hepatic abscess is increased in patients undergoing staged pancreaticoduodenectomy followed by liver-directed therapy.

Original languageEnglish (US)
Pages (from-to)142-148
Number of pages7
JournalAnnals of surgery
Volume252
Issue number1
DOIs
StatePublished - Jul 1 2010

ASJC Scopus subject areas

  • Surgery

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