ThP4.4 - Is it always just a Whipple? A not insignificant number of patients require a concomitant procedure at the time of pancreatoduodenectomy

Abstract Background Some patients may need to undergo an additional procedure at the time of their pancreatoduodenectomy (PD). This study aimed to investigate the proportion of patients that this includes and to describe the additional procedures that these patients undergo. Methods Data were extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study (29 centres from eight countries, n=1484). The group that underwent a concomitant procedure was compared to the group that did not (chi-squared test). Results Out of 1484 PD patients, 79 (5.3%) underwent a concomitant procedure (seven excluded due to missing data). This was most commonly: right hemicolectomy (14, 17.7%), liver excision biopsy (12, 15.2%), appendicectomy (11, 13.9%), adhesiolysis (6, 11.4%), cholangioscopy (5, 6.3%), incisional/ventral hernia repair (5, 6.3%), diagnostic laparoscopy (5, 6.3%) and splenectomy (5, 6.3%). When those who underwent an additional procedure were compared to those who did not, length of stay (both 13 days, p=0.7), as well as rates of return to theatre (7.6% vs 4.9%, p=0.3), 90-day mortality (5.1% vs 3.6%, p=0.5) and five-year survival (38.0% vs 31.5%) did not differ significantly. However, 30-day readmission was significantly higher among those who underwent a concomitant procedure (16.4% vs 8.7%, p=0.02). Conclusion In our multicentre study of PD outcomes, 5.3% of patients underwent an additional procedure at the time of their Whipple. These patients more commonly had an unplanned return to theatre.