Effect of skeletal muscle area and prognostic nutritional index in periampullary tumors.

INTRODUCTION: The skeletal muscle area (SMA) and prognostic nutritional index (PNI) are both considered as predictive parameters for mortality and morbidity for various type of cancer. In this study, we aimed to identify the effects of pre-operative SMA and PNI values on post-operative mortality and morbidity in patients with periampullary region tumors (PRT). METHODS: Patients between 2010 and 2020 were retrospectively analyzed and divided into two groups according to SMA and PNI cutoff values. Univariate and multivariate analysis was performed to find potential risk factors. RESULTS: The mean age was 65.94 ± 11.242 and 54 (60.6%) of the patients were male. Hypertension was found a reducing factor for morbidity in both univariate and multivariate analysis (p = 0.039; p = 0.045). Chronic obstructive pulmonary disease and low PNI were found as factors affecting mortality in univariate analysis (p = 0.046; p = 0.014). However, only low PNI was found as an enhancing factor for mortality in multivariate analysis. CONCLUSION: Although SMA is not a risk factor for post-operative morbidity and mortality, PNI can be considered as a risk factor for mortality in patients with PRT.

INTRODUCCIÓN: El área del músculo esquelético (SMA) y el índice nutricional pronóstico (PNI) se consideran parámetros predictivos de mortalidad y morbilidad para varios tipos de cáncer. En este estudio, nuestro objetivo fue identificar los efectos de los valores preoperatorios de SMA y PNI sobre la mortalidad postoperatoria. y morbilidad en pacientes con tumores de la región periampular (PRT). MÉTODOS: Los pacientes entre 2010-2020 fueron analizados retrospectivamente y divididos en dos grupos según los valores de corte de SMA y PNI. Se realizaron análisis univariados y multivariados para encontrar posibles factores de riesgo. RESULTADOS: La edad media fue de 65.94 ± 11.242 y 54 (60.6%) de los pacientes eran varones. Se encontró que la hipertensión es un factor reductor de la morbilidad tanto en el análisis univariado como en el multivariado (p = 0.039; p = 0.045). La EPOC y el PNI bajo se encontraron como factores que influyen en la mortalidad en el análisis univariante (p = 0.046; p = 0.014). Sin embargo, solo el PNI bajo se encontró como un factor potenciador de la mortalidad en el análisis multivariado. CONCLUSIÓN: Aunque la SMA no se consideró un factor de riesgo de morbilidad y mortalidad posoperatorias; La PNI puede considerarse un factor de riesgo de mortalidad en pacientes con PRT.

Duct-to-Mucosa Pancreaticojejunostomy with Less Serosal Stitches: A Different Approach to Well-known Problem.

OBJECTIVE: To describe a new approach (duct-to-mucosa pancreaticojejunostomy with less serosal stiches) for postoperative pancreatic fistula (POPF) in pancreaticoduodenectomy. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Tepecik Training and Research Hospital, Izmir, Turkey, between January 2019 and May 2020. METHODOLOGY: Medical records of 45 patients, who underwent pancreaticoduodenectomy by the same general surgeon between January 2019 and May 2020, were reviewed retrospectively. Pylorus-preserved pancreaticoduodenectomy was performed for all patients. Duct-to-mucosa PJ with less serosal suture technique was used for all patients in reconstruction after pancreaticoduodenectomy. Definition of the ISGPS was used for the POPF and only grade B and C fistulas were accepted as clinically relevant POPF. Here, the descriptive measures were reported. RESULTS: Seventeen (17) of the forty-five (45) patients were females and median age was sixty- six (66) years. The majority of the underlying disease was pancreatic adoneocarcinoma. Hyperbilirunemia was seen in 15 patients. Median operation time was 360 minutes. Number of patients with pancreatic duct size <3 mm was five. Rate of soft pancreas texture was 33.3%. Lastly, the number of patients that underwent vascular resection or additional organ resection were 6 (13.3%) and 8 (17.8%), respectively. Clinically relevant POPF according to ISGPS was seen in 6 patients (grade B:4 and grade C:2). The most prevalent postoperative complication was surgical site infection at a rate of 40%. There was no POPF related mortality. CONCLUSION: Two-layer duct-to-mucosa pancreaticojejunostomy with less serosal stitches technique has acceptable pancreatic fistula rates. This technique could be used by surgeons who are faced with challenges with the duct-to-mucosa anastomosis due to aforementioned causes. Large multi-centre randomised future studies are required to confirm these findings. Key Words: Postoperative pancreatic fistula, Surgical technique, Duct-to-mucosa pancreaticojejunostomy, Less serosal stiches.