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BJS Open Nov 2023Pancreatoduodenectomy (PD) is associated with significant postoperative morbidity. Surgeons should have a sound understanding of the potential complications for...
BACKGROUND
Pancreatoduodenectomy (PD) is associated with significant postoperative morbidity. Surgeons should have a sound understanding of the potential complications for consenting and benchmarking purposes. Furthermore, preoperative identification of high-risk patients can guide patient selection and potentially allow for targeted prehabilitation and/or individualized treatment regimens. Using a large multicentre cohort, this study aimed to calculate the incidence of all PD complications and identify risk factors.
METHOD
Data were extracted from the Recurrence After Whipple's (RAW) study, a retrospective cohort study of PD outcomes (29 centres from 8 countries, 2012-2015). The incidence and severity of all complications was recorded and potential risk factors for morbidity, major morbidity (Clavien-Dindo grade > IIIa), postoperative pancreatic fistula (POPF), post-pancreatectomy haemorrhage (PPH) and 90-day mortality were investigated.
RESULTS
Among the 1348 included patients, overall morbidity, major morbidity, POPF, PPH and perioperative death affected 53 per cent (n = 720), 17 per cent (n = 228), 8 per cent (n = 108), 6 per cent (n = 84) and 4 per cent (n = 53), respectively. Following multivariable tests, a high BMI (P = 0.007), an ASA grade > II (P < 0.0001) and a classic Whipple approach (P = 0.005) were all associated with increased overall morbidity. In addition, ASA grade > II patients were at increased risk of major morbidity (P < 0.0001), and a raised BMI correlated with a greater risk of POPF (P = 0.001).
CONCLUSION
In this multicentre study of PD outcomes, an ASA grade > II was a risk factor for major morbidity and a high BMI was a risk factor for POPF. Patients who are preoperatively identified to be high risk may benefit from targeted prehabilitation or individualized treatment regimens.
Topics: Humans; Pancreaticoduodenectomy; Retrospective Studies; Pancreas; Postoperative Complications; Pancreatic Fistula; Pancreatic Neoplasms
PubMed: 38036696
DOI: 10.1093/bjsopen/zrad106 -
HPB : the Official Journal of the... Jun 2017There is an increasing needed to consider pancreaticoduodenectomy (PD) for the treatment of pancreatic and periampullary malignancy in patients aged 80 and over, given... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There is an increasing needed to consider pancreaticoduodenectomy (PD) for the treatment of pancreatic and periampullary malignancy in patients aged 80 and over, given the increasing aging population.
METHODS
A systematic literature search was undertaken to identify selected studies that compared the outcomes of patients aged 80 years or over to those younger undergoing PD.
RESULTS
In total 18 studies were included for evaluation. Octogenarian or older populations had significantly higher 30-day post-operative mortality rate (OR: 2.22, 95% CI = 1.48-3.31, p < 0.001) and length of hospital stay (OR: 2.23, 95% CI = 1.36-3.10, p < 0.001). The overall post-operative complication rate was higher in the older group compared to the younger population (OR: 1.51, 95% CI = 1.25-1.83, p < 0.001). Elderly patients were more likely to develop pneumonia (OR: 1.72, 95% CI = 1.39-2.13, p < 0.001) and experience delayed gastric emptying (DGE) (OR: 1.77, 95% CI = 1.35-2.31, p < 0.001). The incidence of post-operative pancreatic fistula and bile leak were not significantly different between the groups. Rehabilitation and home nursing care services was also more frequently required by the older patient group at the time of hospital discharge.
CONCLUSION
Patients aged 80 years and older have approximately double the risk of 30-day post-operative mortality and 50% increased rate of complications following PD. Careful patient selection is required when offering surgery in this age group.
Topics: Age Factors; Aged; Aged, 80 and over; Chi-Square Distribution; Female; Health Status; Humans; Length of Stay; Male; Odds Ratio; Pancreaticoduodenectomy; Patient Selection; Postoperative Complications; Risk Factors; Time Factors; Treatment Outcome
PubMed: 28292633
DOI: 10.1016/j.hpb.2017.01.018 -
HPB : the Official Journal of the... Jan 2016To review the evidence on the safety and efficacy of hepatopancreatoduodenectomy for biliary and gallbladder cancers. (Review)
Review
OBJECTIVES
To review the evidence on the safety and efficacy of hepatopancreatoduodenectomy for biliary and gallbladder cancers.
METHODS
Medline and EMBASE were systematically searched for papers of hepatopancreatoduodenectomy in patients with biliary and gallbladder cancers.
RESULTS
Eighteen studies involving 397 patients were reviewed. Major hepatectomy was undertaken in 81.3% of the 397 patients and the R0 resection rate was 71.3%. The morbidity and mortality rates were 78.9% and 10.3%, respectively. The 5-year overall survival rate ranged from 3% to 50% (median = 31%). The 5-year survival rate in patients who underwent curative resection was 18-68.8% (median = 51.3%), and 0% in patients who received non-curative resection.
CONCLUSIONS
Hepatopancreatoduodenectomy is a challenging procedure with high morbidity and mortality rates. However, this procedure can provide a chance of long-term survival in patients in whom curative resection is feasible.
Topics: Aged; Biliary Tract Neoplasms; Female; Gallbladder Neoplasms; Hepatectomy; Humans; Male; Middle Aged; Pancreaticoduodenectomy; Risk Factors; Survival Analysis; Survival Rate; Time Factors; Treatment Outcome
PubMed: 26776844
DOI: 10.1016/j.hpb.2015.07.008 -
HPB : the Official Journal of the... Oct 2012The aim of this meta-analysis was to analyse the outcomes of major pancreatic surgery among the elderly (≥75 and ≥80 years of age). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The aim of this meta-analysis was to analyse the outcomes of major pancreatic surgery among the elderly (≥75 and ≥80 years of age).
METHODS
A systematic literature search was conducted using Embase, MEDLINE, Cochrane and PubMed databases on all studies published between January 1990 and April 2012 reporting peri-operative outcomes after a pancreaticoduodenectomy (PD) among the elderly. Primary end-points measured were peri-operative mortality and the incidence of post-operative complications. Secondary outcomes considered included the incidence of post-operative pancreatic fistula formation (POPF), delayed gastric emptying (DGE), wound infection, pneumonia, post-operative bleeding and length of hospital stay.
RESULTS
Eleven trials were included comprising 5186 patients; 7 studies comparing endpoints in patients aged ≥75 years vs. younger populations and 4 studies comparing endpoints in patients aged ≥80 years vs. younger populations. In both groups, there was a statistically significant increase in the incidence of mortality and post-operative pneumonia in the elderly population. The incidence of post-operative complications was also found to be statistically significant among patients ≥80 years of age vs. their younger cohorts.
CONCLUSIONS
There is an increased incidence of post-operative mortality and pneumonia after a PD among all elderly patients ≥75 years of age, as well as an increased incidence of post-operative complications among patients ≥80 years of age. Additional randomized control trials studying post-PD operative outcomes in elderly vs. younger patients with standardization of comorbidities is therefore necessary to confirm the conclusions presented here.
Topics: Age Factors; Aged; Aged, 80 and over; Female; Humans; Incidence; Male; Odds Ratio; Pancreatic Neoplasms; Pancreaticoduodenectomy; Pneumonia; Postoperative Complications; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 22954000
DOI: 10.1111/j.1477-2574.2012.00506.x -
HPB : the Official Journal of the... Sep 2012In 2005 the International Study Group for Pancreatic Fistula (ISGPF) created a definition and grading system for pancreatic fistulae (PF) in which grade C denotes the... (Review)
Review
BACKGROUND
In 2005 the International Study Group for Pancreatic Fistula (ISGPF) created a definition and grading system for pancreatic fistulae (PF) in which grade C denotes the most severe and potentially life-threatening type. Factors and outcomes associated with grade C fistulae have been ill defined.
METHODS
Systematic searches of PubMed and EMBASE were conducted by two independent reviewers utilizing the keywords 'pancreaticoduodenectomy' (PD) and 'pancreatic fistula'. Inclusion criteria were: (i) a sample of ≥100 patients; (ii) consecutive accrual of all pathologies, and (iii) use of the ISGPF definition and grading system. Quality appraisal and data extraction were performed using pilot-tested templates.
RESULTS
Fourteen articles describing a total of 2706 PDs met the study entrance criteria. Pancreatic fistulae occurred in 479 patients (18%) and included 71 grade C PF that were directly responsible for 25 deaths (35% mortality rate). Only two studies analysed risk factors; these found soft pancreatic texture and histology other than adenocarcinoma to be the most common risk factors. Ten studies reported management strategies and indicated that 51% of patients required reoperation.
CONCLUSIONS
Grade C PF: (i) accounts for 15% of fistulae following PD and has an associated mortality rate of 35%; (ii) occurs most commonly in pathology associated with a soft remnant, and (iii) requires reoperation in approximately one half of patients. The published literature incompletely describes grade C PF.
Topics: Humans; Incidence; Pancreatic Fistula; Pancreaticoduodenectomy; Reoperation; Risk Assessment; Risk Factors; Severity of Illness Index; Treatment Outcome
PubMed: 22882195
DOI: 10.1111/j.1477-2574.2012.00486.x -
Medicine Apr 2023Laparoscopic pancreaticoduodenectomy (LPD) is a technically demanding procedure but is gradually gaining acceptance in clinical practice. This study was performed to...
Laparoscopic pancreaticoduodenectomy (LPD) is a technically demanding procedure but is gradually gaining acceptance in clinical practice. This study was performed to compare the short-term outcomes of LPD with open pancreaticoduodenectomy (OPD). The perioperative data of the patients who underwent LPD (n = 25) and OPD (n = 40) from January 1, 2017 to December 31, 2021 at Zhangjiagang Hospital Affiliated to Soochow University were collected and retrospectively analyzed. All patients received R0 resection, and none of the patients died within the perioperative period. The preoperative data (gender, age, body mass index [BMI], and preoperative bilirubin), the intraoperative data (operative time, number of retrieved lymph nodes), and postoperative data (level 1 monitoring time, postoperative fluid diet time, postoperative fluid feeding time, and hospitalization cost) were comparable between the 2 groups (P > .05). The estimated blood loss, abdominal drainage tube removal time, postoperative hospital stay, catheter removal time, and analgesic drug use were significantly lesser in the LPD group, when compared to the OPD group (P < .05). LPD is safe and feasible. Compared to OPD, LPD has less surgical trauma, less intraoperative bleeding, and faster postoperative recovery.
Topics: Humans; Pancreaticoduodenectomy; Retrospective Studies; Pancreatic Neoplasms; Postoperative Complications; Length of Stay; Treatment Outcome; Laparoscopy
PubMed: 37083770
DOI: 10.1097/MD.0000000000033588 -
Journal of Surgical Oncology Jan 2023To investigate the impact of race/ethnicity on surgical outcomes following pancreaticoduodenectomy for pancreatic cancer.
PURPOSE
To investigate the impact of race/ethnicity on surgical outcomes following pancreaticoduodenectomy for pancreatic cancer.
METHODS
A retrospective review of patients undergoing pancreaticoduodenectomy for adenocarcinoma in the National Surgical Quality Improvement Program (NSQIP) database from 2014 to 2019. Patient and tumor characteristics and 30-day postoperative outcomes were compared. Multivariable logistic and linear regression models were conducted to investigate the relationship between race/ethnicity and surgical outcomes.
RESULTS
Six thousand five hundred and sixty-two patients were included (84.5% White, 7.9% Black, 3% Hispanic, 4.6% Asian). Larger proportions of Blacks had preoperative American Society of Anesthesiologists class 3 or 4. There were no significant differences in tumor characteristics or operative techniques. A smaller proportion of Asians and Hispanics received neoadjuvant chemotherapy and/or radiation than Blacks and Whites. Relative to White, the Black race was independently associated with postoperative sepsis and reoperation. Both Black and Hispanic race/ethnicity were associated with prolonged intubation and delayed gastric emptying, and minorities races/ethnicities were associated with longer length of hospital stay. Relative to White, Hispanic, and Asian race/ethnicity were independently associated with a lower likelihood of neoadjuvant therapy (NAT) receipt.
CONCLUSION
In ACS-NSQIP participating hospitals, non-White race/ethnicity was independently associated with adverse outcomes after pancreatic cancer resection. A possible disparity in NAT receipt may exist in Asian and Hispanic patients undergoing surgical resection.
Topics: Humans; Pancreaticoduodenectomy; Ethnicity; Pancreatic Neoplasms; Postoperative Complications
PubMed: 36177773
DOI: 10.1002/jso.27113 -
World Journal of Gastroenterology Feb 2024Pancreatic surgery is challenging owing to the anatomical characteristics of the pancreas. Increasing attention has been paid to changes in quality of life (QOL) after...
BACKGROUND
Pancreatic surgery is challenging owing to the anatomical characteristics of the pancreas. Increasing attention has been paid to changes in quality of life (QOL) after pancreatic surgery.
AIM
To summarize and analyze current research results on QOL after pancreatic surgery.
METHODS
A systematic search of the literature available on PubMed and EMBASE was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies were identified by screening the references of retrieved articles. Studies on patients' QOL after pancreatic surgery published after January 1, 2012, were included. These included prospective and retrospective studies on patients' QOL after several types of pancreatic surgeries. The results of these primary studies were summarized inductively.
RESULTS
A total of 45 articles were included in the study, of which 13 were related to pancreaticoduodenectomy (PD), seven to duodenum-preserving pancreatic head resection (DPPHR), nine to distal pancreatectomy (DP), two to central pancreatectomy (CP), and 14 to total pancreatectomy (TP). Some studies showed that 3-6 months were needed for QOL recovery after PD, whereas others showed that 6-12 months was more accurate. Although TP and PD had similar influences on QOL, patients needed longer to recover to preoperative or baseline levels after TP. The QOL was better after DPPHR than PD. However, the superiority of the QOL between patients who underwent CP and PD remains controversial. The decrease in exocrine and endocrine functions postoperatively was the main factor affecting the QOL. Minimally invasive surgery could improve patients' QOL in the early stages after PD and DP; however, the long-term effect remains unclear.
CONCLUSION
The procedure among PD, DP, CP, and TP with a superior postoperative QOL is controversial. The long-term benefits of minimally invasive versus open surgeries remain unclear. Further prospective trials are warranted.
Topics: Humans; Quality of Life; Retrospective Studies; Pancreas; Pancreatectomy; Pancreaticoduodenectomy; Pancreatic Neoplasms; Postoperative Complications
PubMed: 38516249
DOI: 10.3748/wjg.v30.i8.943 -
World Journal of Surgery Dec 2023The presence of an aberrant right hepatic artery (a-RHA) could influence the oncological and postoperative results after pancreaticoduodenectomy (PD). (Meta-Analysis)
Meta-Analysis Review
The Presence of an Aberrant Right Hepatic Artery Did Not Influence Surgical and Oncological Outcomes After Pancreaticoduodenectomy: A Comprehensive Systematic Review and Meta-Analysis.
BACKGROUND
The presence of an aberrant right hepatic artery (a-RHA) could influence the oncological and postoperative results after pancreaticoduodenectomy (PD).
METHODS
A systematic review and metanalysis were conducted, including all comparative studies having patients who underwent PD without (na-RHA) or with a-RHA. The results were reported as risk ratios (RRs), mean differences (MDs), or hazard ratios (HRs) with 95% confidence intervals (95 CI). The random effects model was used to calculate the effect sizes. The endpoints were distinguished as critical and important. Critical endpoints were: R1 resection, overall survival (OS), morbidity, mortality, and biliary fistula (BL). Important endpoints were: postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), post pancreatectomy hemorrhage (PPH), length of stay (LOS), and operative time (OT).
RESULTS
Considering the R1 rate no significant differences were observed between the two groups (RR 1.06; 0.89 to 1.27). The two groups have a similar OS (HR 0.95; 0.85 to 1.06). Postoperative morbidity and mortality were similar between the two groups, with a RR of 0.97 (0.88 to 1.06) and 0.81 (0.54 to 1.20), respectively. The biliary fistula rate was similar between the two groups (RR of 1.09; 0.72 to 1.66). No differences were observed for non-critical endpoints.
CONCLUSION
The presence of a-RHA does not affect negatively the short-term and long-term clinical outcomes of PD.
Topics: Humans; Pancreaticoduodenectomy; Pancreatectomy; Biliary Fistula; Hepatic Artery; Pancreas; Pancreatic Fistula; Postoperative Complications
PubMed: 37816977
DOI: 10.1007/s00268-023-07191-2 -
Pancreatology : Official Journal of the... Jun 2024Postoperative pancreatic fistula (POPF) is a major cause of morbidity and mortality after pancreatoduodenectomy (PD), and previous research has focused on... (Review)
Review
Postoperative pancreatic fistula (POPF) is a major cause of morbidity and mortality after pancreatoduodenectomy (PD), and previous research has focused on patient-related risk factors and comparisons between anastomotic techniques. However, it is recognized that surgeon experience is an important factor in POPF outcomes, and that there is a significant learning curve for the pancreatic anastomosis. The aim of this study was to review the current literature on training models for the pancreatic anastomosis, and to explore areas for future research. It is concluded that research is needed to understand the mechanical properties of the human pancreas in an effort to develop a synthetic model that closely mimics its mechanical properties. Virtual reality (VR) is an attractive alternative to synthetic models for surgical training, and further work is needed to develop a VR pancreatic anastomosis training module that provides both high fidelity and haptic feedback.
Topics: Humans; Anastomosis, Surgical; Pancreas; Pancreaticoduodenectomy; Pancreatic Fistula; Virtual Reality; Models, Anatomic
PubMed: 38580492
DOI: 10.1016/j.pan.2024.03.020