Reexploration for XXXX : resectability, perioperative results, pathology, and long-term outcome.

@entity1 @entity5 @entity190 @entity189
OBJECTIVE: This single-institution experience retrospectively reviews the outcomes of @entity1 undergoing reexploration for @entity189 at a high-volume center. SUMMARY BACKGROUND DATA: Many @entity1 are referred to tertiary centers with @entity189 after their @entity5 were deemed unresectable at previous laparotomy. In carefully selected @entity1 , @entity5 resection is often possible; however, the perioperative results and long-term outcome have not been well defined. METHODS: From November 1991 through December 1997, 78 @entity1 who underwent previous exploratory laparotomy and/or palliative surgery for suspected @entity189 underwent reexploration. The operative outcome, resectability rate, pathology, and long-term survival rate were compared with 690 concurrent @entity1 who had not undergone previous exploratory surgery. RESULTS: Fifty-two of the 78 @entity1 (67%) undergoing reexploration underwent successful resection by pancreaticoduodenectomy; the remaining 26 @entity1 (34%) were deemed to have unresectable disease. Compared with the 690 @entity1 who had not undergone recent related surgery, the @entity1 in the reoperative group were similar with respect to gender, race, and resectability rate but were significantly younger. The distribution of @entity5 by site in the reoperative group undergoing pancreaticoduodenectomy (n = 52) was 60%, 19%, 15%, and 6% for pancreatic, ampullary, distal bile duct, and duodenal @entity5 , respectively. These figures were similar to the 65%, 14%, 16% and 5% for resectable @entity5 found in the primary surgery group (n = 460). Intraoperative @entity190 and transfusion requirements did not differ between the two groups. However, the mean operative time was 7.4 hours in the reoperative group, significantly longer than in the control group. On pathologic examination, reoperative @entity1 had @entity5 , and the percentage of @entity1 with positive lymph nodes in the resection specimen was significantly less. The incidence of positive margins was similar between the two groups. Postoperative lengths of stay, complication rates, and perioperative mortality rates were not higher in reoperative @entity1 . The long-term survival rate was similar between the two resected groups, with a median survival of 24 months in the reoperative group and 20 months in those without previous exploration. CONCLUSIONS: These data demonstrate that @entity1 undergoing reoperation for @entity189 have similar resectability, perioperative morbidity and mortality, and long-term survival rates as @entity1 undergoing initial exploration. The results suggest that selected @entity1 considered to have unresectable disease at previous surgery should undergo restaging and reexploration at specialized high-volume centers.
