Our Summary

This research paper looks at a complex surgical procedure known as pancreatoduodenectomy, which involves the removal of the pancreas. Sometimes, this operation also requires the removal of a part of the colon, which is known as a colectomy. The study hypothesized that adding a colectomy to the procedure could increase the associated risks.

The researchers looked back at data from surgeries performed between 2014 and 2019. They compared operations where only the pancreas was removed with those where both the pancreas and a part of the colon were removed. They considered various factors like patient characteristics, disease traits, and what happened during and after the operation.

They found that out of over 24,000 pancreas removal surgeries, about 2% also involved a colectomy. The patients who had both procedures done had fewer health issues like obesity, high blood pressure, and diabetes. However, they were more likely to have a cancer diagnosis, require vascular resection, and have longer surgery times.

The results showed that adding a colectomy to the pancreas removal procedure significantly increased the chance of serious health problems after the operation. However, it did not increase the chance of death. The researchers suggest that this information should be considered when planning the surgery, counseling patients beforehand, and deciding the order of cancer treatments.

FAQs

  1. What is the impact of concurrent colectomy on the risk associated with pancreatoduodenectomy?
  2. Does concurrent colectomy at the time of pancreatoduodenectomy increase the odds of mortality?
  3. How does concurrent colectomy during pancreatoduodenectomy affect patients with comorbidities like obesity, hypertension, and diabetes?

Doctor’s Tip

A helpful tip a doctor might tell a patient about colectomy is to be aware that concurrent colectomy at the time of pancreatoduodenectomy can increase the risk of serious morbidity. It is important for patients to discuss this with their healthcare provider and consider it in their operative planning, preoperative counseling, and sequencing of cancer-directed treatments.

Suitable For

Patients who are typically recommended colectomy are those with locally advanced tumors that require concurrent colectomy during a pancreatoduodenectomy. These patients may have a malignant diagnosis, require vascular resection, and have longer operative times. It is important to consider the increased risk of serious morbidity associated with concurrent colectomy when planning the operation, counseling patients, and sequencing cancer-directed treatments.

Timeline

  • Before colectomy: The patient may undergo diagnostic tests and imaging to determine the need for colectomy. The patient will likely meet with a surgeon to discuss the procedure, potential risks, benefits, and expected outcomes. Preoperative preparation may include bowel preparation and dietary restrictions.

  • Day of colectomy: The patient will be admitted to the hospital and prepared for surgery. The surgery will typically last several hours, during which the colon or a portion of it will be removed. The patient will then be taken to the recovery room and monitored closely for any complications.

  • After colectomy: The patient will stay in the hospital for a period of time to recover. They may experience pain, discomfort, and changes in bowel function. The medical team will closely monitor the patient for any signs of infection, bleeding, or other complications. The patient will gradually resume eating and drinking, and may receive physical therapy to aid in recovery.

  • Follow-up care: The patient will have follow-up appointments with their surgeon to monitor their recovery and address any concerns. The patient may also need ongoing management of their bowel function and diet to adjust to the changes after colectomy. In some cases, additional treatments such as chemotherapy or radiation therapy may be recommended.

What to Ask Your Doctor

Some questions a patient should ask their doctor about colectomy include:

  1. Why is a colectomy being recommended in addition to my pancreatoduodenectomy?
  2. What are the potential risks and complications associated with a concurrent colectomy?
  3. How will a colectomy affect my recovery time and overall prognosis?
  4. Are there any alternative treatment options to consider instead of a colectomy?
  5. What is the experience and success rate of the surgical team in performing concurrent colectomies?
  6. How will a colectomy impact my quality of life after surgery?
  7. What follow-up care will be needed after a colectomy, and what long-term effects should I expect?
  8. Are there any specific dietary or lifestyle changes I should make after a colectomy?
  9. How will a colectomy affect my ability to digest food and absorb nutrients?
  10. What support resources are available for patients undergoing a colectomy?

Reference

Authors: Harris LB, Osborn TA, Bennett JL, Jensen HK, Giorgakis E, Mavros MN. Journal: J Hepatobiliary Pancreat Sci. 2023 May;30(5):655-663. doi: 10.1002/jhbp.1259. Epub 2022 Nov 11. PMID: 36282586