Combined right nephrectomy and pancreaticoduodenectomy. Indications and outcomes.

CONTEXT Nephrectomy and pancreaticoduodenctomy are operations often performed for the treatment of malignancy. However, the combination of both procedures is rarely reported. OBJECTIVES The indications and outcomes of combined right nephrectomy and pancreaticoduodenectomy were assessed. STUDY DESIGN Patients were identified from a prospective operative database between 2002 and 2008. SETTING A tertiary care center. PATIENTS One-hundred and 80 patients undergoing pancreaticoduodenectomy. There were 5 (2.8%) patients treated by combined right nephrectomy and pancreaticoduodenal resection. MAIN OUTCOME MEASURE Description of these 5 patients. RESULTS Three patients had retroperitoneal sarcomas adherent to the right kidney and duodenum, one patient had a locally advanced transitional-cell carcinoma and the remaining patient presented with an ampullary malignancy and concurrent right renal tumor All patients underwent en bloc resection with clear margins. Median operating time was 13 hours (range: 9-21 hours). There was no perioperative mortality in this series. Complications were noted in 3 (60%) patients related to pancreaticoduodenal resection and all were managed conservatively without significant clinical impact. Median post-operative hospital stay was 8 days (range: 7-11 days). At a median follow-up of 14 months (range: 3-36 months) all patients were alive without evidence of disease recurrence. CONCLUSION En bloc right nephrectomy combined with pancreaticoduodenal resection can be performed in selected patients with malignant tumors with acceptable morbidity to achieve clear resection margins.