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Hepato-gastroenterology 2015To systematically determine the effect of omental flap in pancreaticoduodenectomy against postoperative complication through metaanalysis of published studies. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/AIMS
To systematically determine the effect of omental flap in pancreaticoduodenectomy against postoperative complication through metaanalysis of published studies.
METHODOLOGY
Thorough literature search in Ovid-MEDLINE and EMBASE databases was conducted to identify studies whether the use of Omental Flap to prevent postoperative complications. Review of 14 article candidates, identified 4 eligible articles with a total of 2971 patients for meta-analysis. Dichotomous data regarding distinction between omental roll-up and nonmental roll-up were pooled using random effects model to obtain the diagnostic odds ratios and their 95% confidence intervals (CIs).
RESULTS
1129 patients in omental roll-up group, 1842 patients in nonomental group. Omental roll-up during pancreaticoduodenectomy could not prevent postoperative pancreatic fistula (OR=0.81, 95%CI 0.40-1.63, P=0.56). it also could not prevent postoperative intra-abdominal bleeding (OR=0.67, 95%CI 0.28-1.59, P=0.37). We use the sensitivity analysis which found The pancreatic fistula was lower in the nonomental roll-up group than in the omental roll-up group (OR=1.24, 95%CI 1.03-1.50, P=0.02).
CONCLUSIONS
The use of omental roll-up could not decrease the risk of pancreatic fistula after pancreaticoduodenectomy. Further randomized controlled trials are needed to identify the effect of omental roll-up technique for pancreaticoduodenectomy.
Topics: Chi-Square Distribution; Gastrointestinal Hemorrhage; Humans; Odds Ratio; Omentum; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Hemorrhage; Risk Factors; Surgical Flaps; Treatment Outcome
PubMed: 25911894
DOI: No ID Found -
Surgery Apr 2021
Invited commentary: Evolving landscape of postoperative hyperamylasemia, postoperative acute pancreatitis, and postoperative pancreatic fistula: Time for a unifying definition.
Topics: Disease Management; Disease Susceptibility; Humans; Hyperamylasemia; Pancreatic Fistula; Pancreaticoduodenectomy; Pancreatitis; Postoperative Complications
PubMed: 33257035
DOI: 10.1016/j.surg.2020.10.024 -
Surgery Sep 2023Machine learning is increasingly advocated to develop prediction models for postoperative complications. It is, however, unclear if machine learning is superior to... (Observational Study)
Observational Study
BACKGROUND
Machine learning is increasingly advocated to develop prediction models for postoperative complications. It is, however, unclear if machine learning is superior to logistic regression when using structured clinical data. Postoperative pancreatic fistula and delayed gastric emptying are the two most common complications with the biggest impact on patient condition and length of hospital stay after pancreatoduodenectomy. This study aimed to compare the performance of machine learning and logistic regression in predicting pancreatic fistula and delayed gastric emptying after pancreatoduodenectomy.
METHODS
This retrospective observational study used nationwide data from 16 centers in the Dutch Pancreatic Cancer Audit between January 2014 and January 2021. The area under the curve of a machine learning and logistic regression model for clinically relevant postoperative pancreatic fistula and delayed gastric emptying were compared.
RESULTS
Overall, 799 (16.3%) patients developed a postoperative pancreatic fistula, and 943 developed (19.2%) delayed gastric emptying. For postoperative pancreatic fistula, the area under the curve of the machine learning model was 0.74, and the area under the curve of the logistic regression model was 0.73. For delayed gastric emptying, the area under the curve of the machine learning model and logistic regression was 0.59.
CONCLUSION
Machine learning did not outperform logistic regression modeling in predicting postoperative complications after pancreatoduodenectomy.
Topics: Humans; Pancreaticoduodenectomy; Pancreatic Fistula; Logistic Models; Gastroparesis; Postoperative Complications; Retrospective Studies; Machine Learning
PubMed: 37150712
DOI: 10.1016/j.surg.2023.03.012 -
Journal of Hepato-biliary-pancreatic... Dec 2021To evaluate a risk-adjusted comparison of clinically relevant postoperative pancreatic fistula POPF (CR-POPF) following laparoscopic pancreatoduodenectomy (LPD) vs open...
BACKGROUND
To evaluate a risk-adjusted comparison of clinically relevant postoperative pancreatic fistula POPF (CR-POPF) following laparoscopic pancreatoduodenectomy (LPD) vs open pancreatoduodenectomy (OPD) using the fistula risk score (FRS).
METHODS
We retrospectively analyzed 579 patients who underwent LPD (n = 274) or OPD (n = 305) between 2012 and 2019 at two tertiary hospitals. Using the FRS, the risk was stratified into four categories; negligible, low, intermediate and high risk.
RESULTS
The median FRS was significantly higher in the LPD than in the OPD group (5.4 ± 1.2 vs 3.9 ± 1.8, P < .001). The overall incidence of CR-POPF in the LPD vs OPD groups were 16.4% vs 17.7% (P = .187). When POPF risks were stratified by FRS, CR-POPF following LPD vs OPD in patients with low risk (0% vs 6.3%, P = .294), intermediate risk (16.1% vs 22.9%, P = .053) and high risk (33.3% vs 27.3%, P = .577) were not significantly different.
CONCLUSION
Despite a higher risk score in the LPD group, the CR-POPF was similar following both procedures in the unadjusted and FRS-risk-adjusted comparisons. The CR-POPF was more significantly affected by patient risk factors such as the soft pancreas and small pancreatic duct.
Topics: Humans; Laparoscopy; Pancreas; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Complications; Retrospective Studies; Risk Factors
PubMed: 33174394
DOI: 10.1002/jhbp.866 -
HPB : the Official Journal of the... Sep 2020The role of wrapping in the setting of pancreaticoduodenectomy (PD) is controversial. This study aimed to assess whether the use of omental or falciform ligament... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The role of wrapping in the setting of pancreaticoduodenectomy (PD) is controversial. This study aimed to assess whether the use of omental or falciform ligament wrapping of pancreatic anastomosis and/or vessels could reduce the rate of POPF and postpancreatectomy hemorrhage (PPH) after PD.
METHODS
Studies comparing PD with (PD-W) and without wrapping (PD-nW) were included. Primary outcomes were POPF and extraluminal PPH. Dichotomous variables were analyzed for risk ratios (RR) with 95% Confidence Intervals.
RESULTS
Nine studies involving 4384 patients were considered. The risk of POPF and clinically relevant POPF (CR-POPF) was similar between patients with and without omental wrapping of pancreatic anastomosis when considered as overall. A significant benefit from wrapping in terms of CR-POPF (RR 0.14, P = 0.002) was reported for patients who underwent PD with pancreaticojejunostomy (PJ). The risk of extraluminal PPH was slightly lower in patients who underwent vessels wrapping compared to those who did not (RR 0.58, P = 0.020). Similar extraluminal PPH rates were reported for patients with and without wrapping of pancreatic anastomosis (P = 0.620).
DISCUSSION
Data from low-evidence studies suggest that omental wrapping of PJ may reduce the incidence of CR-POPF, whereas vessels wrapping may have a slight effect for preventing extraluminal PPH.
Topics: Anastomosis, Surgical; Humans; Ligaments; Pancreatic Fistula; Pancreaticoduodenectomy; Pancreaticojejunostomy; Postoperative Complications
PubMed: 32631806
DOI: 10.1016/j.hpb.2020.05.003 -
HPB : the Official Journal of the... Sep 2021Preoperative chemo- or chemoradiotherapy is recommended for borderline-resectable pancreatic cancer. The aim of this study was to determine the impact of preoperative... (Meta-Analysis)
Meta-Analysis Review
The effect of preoperative chemotherapy and chemoradiotherapy on pancreatic fistula and other surgical complications after pancreatic resection: a systematic review and meta-analysis of comparative studies.
BACKGROUND
Preoperative chemo- or chemoradiotherapy is recommended for borderline-resectable pancreatic cancer. The aim of this study was to determine the impact of preoperative therapy on surgical complications in patients with resected pancreatic cancer.
METHODS
This systematic review and meta-analysis included studies reporting on the rate of surgical complications after preoperative chemo- or chemoradiotherapy versus immediate surgery in pancreatic cancer patients. The primary endpoint was the rate of grade B/C POPF. Pooled odds ratios were calculated using random-effects models.
RESULTS
Forty-one comparative studies including 25,389 patients were included. Vascular resections were more often performed after preoperative therapy (29.4% vs. 15.7%, p < 0.001). Preoperative therapy was associated with a lower rate of grade B/C POPF as compared to immediate surgery (pooled OR 0.47, 95%CI 0.38-0.58). This reduction was mostly obtained by preoperative chemoradiotherapy (OR 0.46, 95%CI 0.29-0.73), but not by preoperative chemotherapy alone (OR 0.83, 95%CI 0.59-1.16). No difference was demonstrated for major morbidity, mortality, postpancreatectomy haemorrhage, delayed gastric emptying and overall morbidity.
CONCLUSION
Preoperative chemo- and chemoradiotherapy in patients with pancreatic cancer appears to be safe with respect to POPF and other surgical complications as compared to immediate surgery. The reduced rate of POPF appears to be attributable to preoperative chemoradiation.
Topics: Chemoradiotherapy; Humans; Neoadjuvant Therapy; Pancreatectomy; Pancreatic Fistula; Pancreatic Neoplasms; Postoperative Complications
PubMed: 34099372
DOI: 10.1016/j.hpb.2021.04.027 -
Khirurgiia 2023To summarize the results of pancreaticoduodenectomy (PD) for pancreatic tumors and complications of chronic pancreatitis regarding prediction and prevention of...
OBJECTIVE
To summarize the results of pancreaticoduodenectomy (PD) for pancreatic tumors and complications of chronic pancreatitis regarding prediction and prevention of postoperative complications.
MATERIAL AND METHODS
There were 336 PD procedures between 2016 and mid-2022 in two centers. We assessed the factors influencing specific postoperative complications (postoperative pancreatitis, pancreatic fistula, gastric stasis, arrosive bleeding). Several risk factors were distinguished: baseline pancreatic disease and tumor size, CT-signs of a «soft» gland, intraoperative assessment of the pancreas, number of functioning acinar structures. We assessed surgical prevention of pancreatic fistula via preserving adequate blood supply to the pancreatic stump. The last one is provided by extended pancreatic resection and reconstructive stage of surgery, i.e. Roux-en-Y hepatico- and duodenojejunostomy with isolation of pancreaticojejunostomy on the second loop.
RESULTS
Postoperative pancreatitis underlies specific complications after PD. The risk of pancreatic fistula in case of postoperative pancreatitis increases by 5.3 times compared to patients without pancreatitis. Postoperative pancreatic fistula is more common in patients with T1 and T2 tumors. According to univariate analysis, only pancreatic fistula significantly affects the risk of gastric stasis. Among 336 people who underwent PD, pancreatic fistula occurred in 69 patients (20.5%), gastric stasis - in 61 (18.2%), pancreatic fistula complicated by arrosive bleeding - in 45 (13.4%) patients. Mortality rate was 3.6% (=15).
CONCLUSION
Modern prognostic criteria are valuable to predict specific complications after PD. A promising way to prevent postoperative pancreatitis can be extended pancreatic resection considering angioarchitectonics of the pancreatic stump. Roux-en-Y pancreaticojejunostomy is advisable to reduce aggressiveness of pancreatic fistula.
Topics: Humans; Pancreaticoduodenectomy; Pancreatic Fistula; Gastroparesis; Pancreaticojejunostomy; Pancreatitis; Postoperative Complications
PubMed: 37186646
DOI: 10.17116/hirurgia202305113 -
HPB : the Official Journal of the... Aug 2021The short-term morbidity associated with post-operative pancreatic fistula (POPF) is well established, however data regarding the long-term impact are lacking. We aim to...
BACKGROUND
The short-term morbidity associated with post-operative pancreatic fistula (POPF) is well established, however data regarding the long-term impact are lacking. We aim to characterize long-term oncologic outcomes of POPF after pancreatic resection through a single institution, retrospective study of pancreatic resections performed for adenocarcinoma from 2009 to 2016.
METHODS
Kaplan-Meier survival analysis, logistic regression, and multivariate analysis (MVA) were used to evaluate impact of POPF on overall survival (OS), disease free survival (DFS), and receipt of adjuvant chemotherapy (AC).
RESULTS
767 patients were included. 82 (10.6%) developed grade B (n = 67) or C (n = 15) POPF. Grade C POPF resulted in decreased OS when compared to no POPF (20.22 vs 26.33 months, p = 0.027) and to grade B POPF (20.22 vs. 26.87 months, p = 0.049). POPF patients were less likely to receive AC than those without POPF (59.5% vs 74.9%, p = 0.003) and grade C POPF were less likely to receive AC than all others (26.7% vs 74.2%, p = 0.0001).
CONCLUSION
POPF patients are less likely to receive AC and more likely to have delay in time to AC. These factors are exacerbated in grade C POPF and likely contribute to decreased OS. These findings validate the clinical significance of the ISGPF definition of POPF.
Topics: Humans; Pancreas; Pancreatectomy; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Complications; Retrospective Studies; Risk Factors
PubMed: 33526357
DOI: 10.1016/j.hpb.2020.12.010 -
The Journal of Surgical Research Jun 2015The management of symptomatic pancreatic fistula after pancreaticoduodenectomy is complex and associated with increased morbidity and mortality. We here report...
BACKGROUND
The management of symptomatic pancreatic fistula after pancreaticoduodenectomy is complex and associated with increased morbidity and mortality. We here report continuous irrigation and drainage of the pancreatic remnant to be a feasible and safe alternative to total pancreatectomy.
MATERIALS AND METHODS
Between 2005 and 2011, patients were analyzed, in which pancreaticojejunal anastomosis was disconnected because of grade C fistula, and catheters for continuous irrigation and drainage were placed close to the pancreatic remnant. Clinical data were monitored and quality of life was evaluated.
RESULTS
A total of 13 of 202 patients undergoing pancreaticoduodenectomy required reoperation due to symptomatic pancreatic fistula. Ninety-day mortality of these patients was 15.3%. Median length of stay on the intensive care unit and total length of stay was 18 d (range 3-45) and 46 d (range 33-96), respectively. Patients with early reoperation (<10 d) had significantly decreased length of stay on the intensive care unit and operation time (P < 0.05). Global health status after a median time of 22 mo (range 6-66) was nearly identical, when compared with that of a healthy control group. Mean follow-up was 44.4 mo (±27.2). Four patients (36.6 %) died during the follow-up period; two patients from tumor recurrence, one patient from pneumonia, and one patient for unknown reasons.
CONCLUSIONS
Treatment of pancreatic fistula by continuous irrigation and drainage of the preserved pancreatic remnant is a simple and feasible alternative to total pancreatectomy. This technique maintains a sufficient endocrine function and is associated with low mortality and reasonable quality of life.
Topics: Aged; Drainage; Female; Humans; Length of Stay; Male; Middle Aged; Pancreatic Fistula; Pancreaticoduodenectomy; Therapeutic Irrigation
PubMed: 25828934
DOI: 10.1016/j.jss.2015.02.047 -
The American Surgeon Apr 2019Postoperative pancreatic fistula (POPF) is a serious complication of pancreaticoduodenectomy. However, the criteria for prompting drainage have not been clarified yet....
Postoperative pancreatic fistula (POPF) is a serious complication of pancreaticoduodenectomy. However, the criteria for prompting drainage have not been clarified yet. We evaluated 80 patients who underwent pancreaticoduodenectomy between 2011 and 2016. Clinically relevant POPF (International Study Group of Postoperative Pancreatic Fistula grade B or C) was evaluated on the basis of the following parameters: changes in pancreatic thickness between preoperation and postoperative day (POD) 4 identified enhanced CT, drain amylase level, laboratory data, and operative factors. POPF occurred in 21 patients (26.3%). The median change in pancreatic thickness before and after operation was 8.33 mm in the POPF-positive group, which was significantly larger than that in the POPF-negative group (3.79 mm, <0.001). In addition, operation time, pancreatic texture, main pancreatic duct diameter, WBC count, C-reactive protein level, and drain amylase level demonstrated significant differences between the groups. In the multivariate analysis, operation time, C-reactive protein level on POD 3, drain amylase level on POD 1, and the change in pancreatic thickness before and after operation were independent risk factors of POPF. The drastic change in pancreatic thickness before and after operation predicted POPF in this study. This might be one of the factors that determine the requirement for drainage.
Topics: Drainage; Edema; Humans; Logistic Models; Multivariate Analysis; Pancreas; Pancreatic Fistula; Pancreaticoduodenectomy; Perioperative Care; Postoperative Complications; Predictive Value of Tests; ROC Curve; Retrospective Studies; Risk Factors; Tomography, X-Ray Computed
PubMed: 31043189
DOI: No ID Found