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Langenbeck's Archives of Surgery Dec 2022Emergency pancreaticoduodenectomy (EPD) is an uncommon surgical procedure; usually, it is performed in traumatic cases, with non-traumatic indications being very rare.... (Review)
Review
PURPOSE
Emergency pancreaticoduodenectomy (EPD) is an uncommon surgical procedure; usually, it is performed in traumatic cases, with non-traumatic indications being very rare. Our review aimed to offer a comprehensive descriptive overview of the characteristics of EPD in non-traumatic settings.
METHODS
Our study is a review of individual participant data. PubMed, Cochrane, Google Scholar and Embase databases were searched. The last search was conducted in March 2022; studies that reported EPD for non-traumatic indications were included in the analysis.
RESULTS
Twenty-six articles were identified, twenty-five providing individual participant data; 17 articles (68%) were case reports. One article was a large retrospective study on the NSQIP (American College of Surgeons National Surgical Quality Improvement) database, which enrolled 409 patients that underwent EPD for malignant causes. From the other studies, we extracted individual participant data for a total of 66 patients. The patients were divided in subgroups, based on the indication for surgery: malignant causes (39.39%), uncontrollable bleeding (19.69%), iatrogenic injuries (30.3%), perforations (4.54%), or ischemic causes (6.06%). The postoperative morbidity was higher for the perforation subgroup. Postoperative pancreatic fistula is the most common complication reported (21.21%); higher rates were reported in the malignant and bleeding subgroups, with no special mention of this complication in the NSQIP database study. Mortality rate was 10.3% in the NSQIP database and higher, 19.69% in the 66-patient cohort; the highest mortality rates were registered in the perforation and ischemic subgroup.
CONCLUSION
EPD is a complex surgical intervention, with important associated morbidity and mortality rates, higher than that in elective settings, although it can be a life-saving procedure in selected cases and should be performed only in high-experience centres.
Topics: Humans; Pancreaticoduodenectomy; Retrospective Studies; Pancreatectomy; Pancreatic Fistula; Postoperative Complications
PubMed: 36280612
DOI: 10.1007/s00423-022-02702-6 -
Annals of Medicine and Surgery (2012) Oct 2022Post-pancreatectomy bleeding is a potentially fatal complication which results from the erosion of the regional visceral arteries, mainly the hepatic artery and stump of... (Review)
Review
BACKGROUND
Post-pancreatectomy bleeding is a potentially fatal complication which results from the erosion of the regional visceral arteries, mainly the hepatic artery and stump of the gastro-duodenal artery, caused by a leak or fistula from the pancreatic anastomosis. The objective of this article is to assess whether wrapping of regional vessels with omentum or falciform/teres ligament following pancreaticoduodenectomy reduces the risk of extra-luminal bleeding.
MATERIALS AND METHOD
Standard medical electronic databases were searched with the help of a local librarian and relevant published randomised controlled trials (RCT) and any type of comparative trial were shortlisted according to the inclusion criteria. The summated outcome of post-operative extra-luminal bleeding in patients undergoing pancreaticoduodenectomy was evaluated using the principles of meta-analysis on RevMan 5 statistical software.
RESULT
Two RCTs and 5 retrospective studies on 4100 patients undergoing pancreaticoduodenectomy were found suitable for this meta-analysis. There were 1404 patients in the wrapping-group (WG) and 2696 patients in the no-wrapping group (NWG). In the random effects model analysis, the incidence of extra-luminal haemorrhage was statistically lower in WG [odds ratio 0.51, 95%, CI (0.31, 0.85), Z = 2.59, P = 0.01]. There was moderate heterogeneity between the studies; however it was not statistically significant.
CONCLUSION
The wrapping of regional vessels (using omentum, falciform ligament or ligamentum teres) following pancreaticoduodenectomy seems to reduce the risk of post-operative extra-luminal bleeding. However, more RCTs of robust quality recruiting a greater number of patients are required to validate these findings as this study presents the combined data of two RCTs and 5 retrospective studies.
PubMed: 36268446
DOI: 10.1016/j.amsu.2022.104618 -
Annals of Hepato-biliary-pancreatic... Feb 2023A systematic review was conducted in compliance with PRISMA statement standards to identify all studies reporting outcomes of laparoscopic resection of benign or... (Review)
Review
A systematic review was conducted in compliance with PRISMA statement standards to identify all studies reporting outcomes of laparoscopic resection of benign or malignant lesions located in caudate lobe of liver. Pooled outcome data were calculated using random-effects models. A total of 196 patients from 12 studies were included. Mean operative time, volume of intraoperative blood loss, and length of hospital stay were 225 minutes (95% confidence interval [CI], 181-269 minutes), 134 mL (95% CI, 85-184 mL), and 7 days (95% CI, 5-9 days), respectively. The pooled risk of need for intraoperative transfusion was 2% (95% CI, 0%-5%). It was 3% (95% CI, 1%-6%) for conversion to open surgery, 6% (95% CI, 0%-19%) for need for intra-abdominal drain, 1% (95% CI, 0%-3%) for postoperative mortality, 2% (95% CI, 0%-4%) for biliary leakage, 2% (95% CI, 0%-4%) for intra-abdominal abscess, 1% (95% CI, 0%-4%) for biliary stenosis, 1% (95% CI, 0%-3%) for postoperative bleeding, 1% (95% CI, 0%-4%) for pancreatic fistula, 2% (95% CI, 1%-5%) for pulmonary complications, 1% (95% CI, 0%-4%) for paralytic ileus, and 1% (95% CI, 0%-4%) for need for reoperation. Although the available evidence is limited, the findings of the current study might be utilized for hypothesis synthesis in future studies. They can be used to inform surgeons and patients about estimated risks of perioperative complications until a higher level of evidence is available.
PubMed: 36245071
DOI: 10.14701/ahbps.22-045 -
Asian Journal of Surgery May 2023Whether early or late drain removal (EDR/LDR) is better for patients after pancreatic resection remains controversial. We aim to systematically evaluate the safety and... (Meta-Analysis)
Meta-Analysis Review
Whether early or late drain removal (EDR/LDR) is better for patients after pancreatic resection remains controversial. We aim to systematically evaluate the safety and efficacy of early or late drain removal in patients who undergo pancreatic resection. We searched seven databases from January 1, 2000, through September 2021, and included randomized controlled trials (RCTs) or observational studies comparing EDR vs. LDR in patients after pancreatic resection. We separately pooled effect estimates across RCTs and observational studies. Finally, we included 4 RCTs with 711 patients and 8 nonRCTs with 7207 patients. Based on the pooled RCT data, compared to LDR, EDR reduced hospital length of stay (LOS) (RR: -2.59, 95% CI: -4.13 to -1.06) and hospital cost (RR: -1022.27, 95% CI: -1990.39 to -54.19). Based on the pooled nonRCT data, EDR may reduce the incidence of all complications (OR: 0.45, 95% CI: 0.32 to 0.63), pancreatic fistula (OR: 0.26, 95% CI: 0.15 to 0.45), wound infection (RR: 0.59, 95% CI: 0.06 to 5.45)), reoperation (OR: 0.62, 95% CI: 0.40 to 0.96) and hospital readmission (OR: 0.57, 95% CI: 0.47 to 0.69). There was an uncertain effect on mortality (OR from pooled nonRCTs: 1.02, 95% CI: 0.41 to 2.53) and delayed gastric emptying (RR from pooled RCTs: 0.76, 95% CI: 0.41 to 1.41). The findings of this meta-analysis suggest that early drain removal is associated with lower hospital cost, is safe and may reduce the incidence of complications compared to late drain removal in patients after pancreaticoduodenectomy.
Topics: Humans; Pancreaticoduodenectomy; Postoperative Complications; Pancreatectomy; Pancreatic Fistula; Reoperation; Length of Stay
PubMed: 36207205
DOI: 10.1016/j.asjsur.2022.09.047 -
Frontiers in Oncology 2022The aim of this study was to compare the safety and overall effect of robotic distal pancreatectomy (RDP) to laparoscopic distal pancreatectomy (LDP) after the learning...
AIM
The aim of this study was to compare the safety and overall effect of robotic distal pancreatectomy (RDP) to laparoscopic distal pancreatectomy (LDP) after the learning curve, especially in perioperative outcome and short-term oncological outcome.
METHODS
A literature search was performed by two authors independently using PubMed, Embase, and Web of Science to identify any studies comparing the results of RDP versus LDP published until 5 January 2022. Only the studies where RDP was performed in more than 35 cases were included in this study. We performed a meta-analysis of operative time, blood loss, reoperation, readmission, hospital stay, overall complications, major complications, postoperative pancreatic fistula (POPF), blood transfusion, conversion to open surgery, spleen preservation, tumor size, R0 resection, and lymph node dissection.
RESULTS
Our search identified 15 eligible studies, totaling 4,062 patients (1,413 RDP). It seems that the RDP group had a higher rate of smaller tumor size than the LDP group (MD: -0.15; 95% CI: -0.20 to -0.09; < 0.00001). Furthermore, compared with LPD, RDP was associated with a higher spleen preservation rate (OR: 2.19; 95% CI: 1.36-3.54; = 0.001) and lower rate of conversion to open surgery (OR: 0.43; 95% CI: 0.33-0.55; < 0.00001). Our study revealed that there were no significant differences in operative time, overall complications, major complications, blood loss, blood transfusion, reoperation, readmission, POPF, and lymph node dissection between RDP and LDP.
CONCLUSIONS
RDP is safe and feasible for distal pancreatectomy compared with LDP, and it can reduce the rate of conversion to open surgery and increase the rate of spleen preservation, which needs to be further confirmed by quality comparative studies with large samples.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/#recordDetails.
PubMed: 36106111
DOI: 10.3389/fonc.2022.954227 -
Surgery Nov 2022This systematic review and meta-analysis aimed to give an overview on the postoperative outcome after a minimally invasive (ie, laparoscopic and robot-assisted) central... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This systematic review and meta-analysis aimed to give an overview on the postoperative outcome after a minimally invasive (ie, laparoscopic and robot-assisted) central pancreatectomy and open central pancreatectomy with a specific emphasis on the postoperative pancreatic fistula. For benign and low-grade malignant lesions in the pancreatic neck and body, central pancreatectomy may be an alternative to distal pancreatectomy. Exocrine and endocrine insufficiency occur less often after central pancreatectomy, but the rate of postoperative pancreatic fistula is higher.
METHODS
An electronic search was performed for studies on elective minimally invasive central pancreatectomy and open central pancreatectomy, which reported on major morbidity and postoperative pancreatic fistula in PubMed, Cochrane Register, Embase, and Google Scholar until June 1, 2021. A review protocol was developed a priori and registered in PROSPERO as CRD42021259738. A meta-regression was performed by using a random effects model.
RESULTS
Overall, 41 studies were included involving 1,004 patients, consisting of 158 laparoscopic minimally invasive central pancreatectomies, 80 robot-assisted minimally invasive central pancreatectomies, and 766 open central pancreatectomies. The overall rate of postoperative pancreatic fistula was 14%, major morbidity 14%, and 30-day mortality 1%. The rates of postoperative pancreatic fistula (17% vs 24%, P = .194), major morbidity (17% vs 14%, P = .672), and new-onset diabetes (3% vs 6%, P = .353) did not differ significantly between minimally invasive central pancreatectomy and open central pancreatectomy, respectively. Minimally invasive central pancreatectomy was associated with significantly fewer blood transfusions, less exocrine pancreatic insufficiency, and fewer readmissions compared with open central pancreatectomy. A meta-regression was performed with a random effects model between minimally invasive central pancreatectomy and open central pancreatectomy and showed no significant difference for postoperative pancreatic fistula (random effects model 0.16 [0.10; 0.24] with P = .789), major morbidity (random effects model 0.20 [0.15; 0.25] with P = .410), and new-onset diabetes mellitus (random effects model 0.04 [0.02; 0.07] with P = .651).
CONCLUSION
In selected patients and in experienced hands, minimally invasive central pancreatectomy is a safe alternative to open central pancreatectomy for benign and low-grade malignant lesions of the neck and body. Ideally, further research should confirm this with the main focus on postoperative pancreatic fistula and endocrine and exocrine insufficiency.
Topics: Humans; Laparoscopy; Pancreas; Pancreatectomy; Pancreatic Fistula; Pancreatic Neoplasms; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 35987787
DOI: 10.1016/j.surg.2022.06.024 -
Journal of Clinical Medicine Jul 2022Postoperative pancreatic fistula (POPF) is one of the most critical complications after pancreatic surgery. The relationship between sarcopenia and outcomes following... (Review)
Review
Postoperative pancreatic fistula (POPF) is one of the most critical complications after pancreatic surgery. The relationship between sarcopenia and outcomes following this type of surgery is debated. The aim of this review was to assess the impact of sarcopenia on the risk of POPF. A literature search was performed using the PubMed database and the reference lists of relevant articles to identify papers about the impact of sarcopenia on POPF in pancreatic surgery. Twenty-one studies published between 2016 and 2021 with a total of 4068 patients were included. Some studies observed a significant difference in the incidence of POPF between the sarcopenic and non-sarcopenic patients undergoing pancreatoduodenectomy. Interestingly, there was a trend of a lower POPF rate in sarcopenic patients than in non-sarcopenic patients. Only one study included patients undergoing distal pancreatectomy specifically. The role of sarcopenia in surgical outcomes is still unclear. A combination of objective CT measurements could be used to predict POPF. It could be assessed by routine preoperative staging CT and could improve preoperative risk stratification in patients undergoing pancreatic surgery.
PubMed: 35887908
DOI: 10.3390/jcm11144144 -
Anticancer Research Jul 2022Minimally invasive pancreaticoduodenectomy (PD) is gaining popularity. The aim of this study was to compare the incidence of postoperative pancreatic fistula (POPF)... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/AIM
Minimally invasive pancreaticoduodenectomy (PD) is gaining popularity. The aim of this study was to compare the incidence of postoperative pancreatic fistula (POPF) after minimally invasive versus open procedures.
MATERIALS AND METHODS
Following the PRISMA statement, literature research was conducted focusing on papers comparing the incidence of POPF after open pancreaticoduodenectomy (OPD) versus minimally invasive pancreaticoduodenectomy (MIPD).
RESULTS
Twenty-one papers were included in this meta-analysis, for a total of 4,448 patients. A total of 2,456 patients (55.2%) underwent OPD, while 1,992 (44.8%) underwent MIPD. Age, ASA score III patients, incidence of pancreatic ductal adenocarcinoma and duct diameter were significantly lower in the MIPD group. No statistically significant differences were found between the OPD and MIPD regarding the incidence of major complications (15.6% vs. 17.0%, respectively, p=0.55), mortality (3.7% vs. 2.4%, p=0.81), and POPF rate (14.3% vs. 12.9%, p=0.25).
CONCLUSION
MIPD and OPD had comparable rates of postoperative complications, postoperative mortality, and POPF.
Topics: Humans; Minimally Invasive Surgical Procedures; Pancreas; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Complications
PubMed: 35790274
DOI: 10.21873/anticanres.15817 -
Medicine Jul 2022Clinically relevant postoperative pancreatic fistula (CR-POPF) is a common and troublesome complication after pancreatoduodenectomy (PD). We conducted a systematic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Clinically relevant postoperative pancreatic fistula (CR-POPF) is a common and troublesome complication after pancreatoduodenectomy (PD). We conducted a systematic review and meta-analysis to identify the risk factors of CR-POPF after PD.
METHODS
We searched PubMed, EMBASE, and Cochrane Library databases for studies related to risk factors of CR-POPF after PD. Odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were extracted from the included studies, then a meta-analysis was conducted. If necessary, sensitivity analysis would be performed by changing the effect model or excluding 1 study at a time. Publication bias was assessed by funnel plot and Begg test and Egger test.
RESULTS
A total of 27 studies with 24,740 patients were included, and CR-POPF occurred in 3843 patients (incidence = 17%, 95% CI: 16%-19%). Male (OR = 1.56, 95% CI: 1.42-1.70), body mass index >25 kg/m2 (OR = 1.98, 95% CI: 1.23-3.18), pancreatic duct diameter <3 mm (OR = 1.87, 95% CI: 1.66-2.12), soft pancreatic texture (OR = 3.49, 95% CI: 2.61-4.67), and blood transfusion (OR = 3.10, 95% CI: 2.01-4.77) can significantly increase the risk of CR-POPF. Pancreatic adenocarcinoma (OR = 0.54, 95% CI: 0.47-0.61), vascular resection (OR = 0.57, 95% CI: 0.39-0.83), and preoperative chemoradiotherapy (OR = 0.68, 95% CI: 0.57-0.81) can significantly decrease the factor of CR-POPF. Diabetes mellitus was not statistically associated with CR-POPF (OR = 0.66, 95% CI: 0.40-1.08). However, the analysis of body mass index, pancreatic texture, and diabetes mellitus had a high heterogeneity, then sensitivity analysis was performed, and the result after sensitivity analysis showed diabetes mellitus can significantly decrease the risk of CR-POPF. There was no significant publication bias in this meta-analysis.
CONCLUSIONS
The current review assessed the effects of different factors on CR-POPF. This can provide a basis for the prevention and management of CR-POPF. Effective interventions targeting the above risk factors should be investigated in future studies for decreasing the occurrence of CR-POPF.
Topics: Adenocarcinoma; Humans; Male; Pancreatic Fistula; Pancreatic Neoplasms; Pancreaticoduodenectomy; Postoperative Complications; Retrospective Studies; Risk Factors
PubMed: 35776984
DOI: 10.1097/MD.0000000000029757 -
The American Surgeon Nov 2023To evaluate comparative outcomes of complete and partial excision of infected mesh following abdominal wall hernia repair. (Meta-Analysis)
Meta-Analysis
BACKGROUND
To evaluate comparative outcomes of complete and partial excision of infected mesh following abdominal wall hernia repair.
METHODS
A systematic search of electronic databases, including MEDLINE, EMBASE, CINAHL, and CENTRAL, and bibliographic reference lists with application of a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits was conducted. Surgical site infection chronic sinus formation, recurrent hernia, and need for reoperation were the evaluated outcome measures.
RESULTS
Six comparative observational studies were identified, reporting a total of 317 patients of whom 193 underwent complete mesh excision and the remaining 123 patients underwent partial mesh excision for an infected mesh following abdominal wall hernia repair. The complete mesh excision was associated with significantly lower rates of SSIs (OR: .36; 95% CI, .16-.81, = .01), chronic sinus formation (OR: .11; 95% CI, .02-.71, = .02), and reoperation (OR: .10; 95% CI, .03-.33, = .0001) compared to the partial mesh excision. There was no significant difference in hernia recurrence rate (OR: 3.96.16, 95% CI .62-25.44, = .15) between two groups. The between-study heterogeneity was moderate in all the analyses.
CONCLUSIONS
Complete mesh excision may be associated with lower SSI, chronic sinus formation and need for reoperation when compared to the partial mesh excision in an infected mesh event. However, the available evidence has failed to report the outcomes with respect to the main confounding factors which, together with other important outcomes such as fistula formation, should be considered by future high quality research.
Topics: Humans; Abdominal Wall; Digestive System Surgical Procedures; Hernia, Ventral; Herniorrhaphy; Recurrence; Surgical Mesh; Surgical Wound Infection
PubMed: 35722833
DOI: 10.1177/00031348221109816