Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.631
Filtrar
1.
Am Surg ; 86(4): 334-340, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32391757

RESUMO

Different kinds of complications after splenectomy in hepatolenticular degeneration patients with hypersplenism have been reported in the past decades, but studies on pancreatic fistula and the corresponding targeted prevention and treatment after splenectomy still remain much unexplored. The present work investigated the pathogenic factors of pancreatic fistula after splenectomy and the variation tendency of amylase in drainage fluid, aiming to verify the significance of monitoring amylase in the abdominal drainage fluid in the early diagnosis of pancreatic fistula after splenectomy. One hundred sixty-seven patients with hepatolenticular degeneration and hypersplenism who underwent splenectomy in the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from January 2016 to August 2018 were selected and analyzed. The amylase in the abdominal drainage fluid was monitored routinely after splenectomy. We also conducted the statistics on the incidence of different types of pancreatic fistula and analyzed the influence factors of pancreatic fistula formation. After splenectomy, biochemical fistula occurred in 11 patients (6.6%), grade B fistula in six patients (3.6%), grade C fistula in one patient (0.6%), and the incidence of pancreatic fistula was 4.2 per cent (biochemical fistula excluded). The amylase in the peritoneal drainage fluid was closely concerned with the incidence of pancreatic fistula according to our statistics. Furthermore, by analyzing the different influence factors of pancreatic fistula, Child-Pugh grading of liver function (P = 0.041), pancreatic texture (P = 0.029), degree of splenomegaly (P = 0.003), and operative method (P = 0.001) were supposed to be closely related to the formation of pancreatic fistula. Monitoring of amylase in peritoneal drainage fluid is regarded as an important physiological parameter in the early diagnosis of pancreatic fistula after splenectomy, which provides effective clinical reference and plays a significant role in preventing the occurrence and development of pancreatic fistula.


Assuntos
Amilases/análise , Líquido Ascítico/química , Degeneração Hepatolenticular/cirurgia , Fístula Pancreática/etiologia , Complicações Pós-Operatórias/epidemiologia , Esplenectomia/efeitos adversos , Esplenomegalia/cirurgia , Adolescente , Adulto , Idoso , Biomarcadores/análise , Criança , Drenagem , Feminino , Degeneração Hepatolenticular/complicações , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Fístula Pancreática/epidemiologia , Fístula Pancreática/prevenção & controle , Esplenomegalia/etiologia , Adulto Jovem
2.
Zhonghua Wai Ke Za Zhi ; 58(2): 114-118, 2020 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-32074810

RESUMO

Objective: To investigate the safety and feasibility of longitudinal transpancreatic U-sutures invaginated pancreatojejunostomy (Chen's pancreaticojejunostomy technique) in laparoscopic pancreaticoduodenectomy (LPD). Methods: Clinical data of 116 consecutive patients who underwent LPD using Chen's pancreaticojejunostomy technique in Hunan Provincial People's Hospital from May 2017 to December 2018 were retrospectively analyzed. Among these patients, 66 were males and 50 were females. The median age was 58 years old (32-84 yeas old). All 116 patients underwent pure laparoscopic whipple procedure with Child reconstruction method, using Chen's pancreaticojejunostomy technique. The intraoperative and postoperative data of patients were analyzed. Results: All 116 patients underwent LPD successfully. The mean operative time was (260.3±33.5) minutes (200-620 minutes). The mean time of pancreaticojejunostomy was (18.2±7.6) minutes (14-35 minutes). The mean time of hepaticojejunostomy was (14.6±6.3) minutes (10-25 minutes). The mean time of gastrojejunostomy was (12.0±5.5) minutes (8-20 minutes). The mean estimated blood loss was (106.0±87.6) ml (20-800 ml). Postoperative complications were: 11.2%(13/116) of cases had postoperative pancreatic fistula (POPF), including 10.3% (12/116) of biochemical fistula and 0.9%(1/116) of grade B POPF, no grade C POPF occurred; 10.3%(12/116) had gastrojejunal anastomotic bleeding; 3.4%(4/116) had hepaticojejunal anastomotic fistula; 3.4%(4/116) had delayed gastric emptying; 4.3% (5/116) had localized abdominal infection; 12.1%(14/116) had pulmonary infection; postoperative mortality were 0(0/116) and 1.7%(2/116) within 30 days and 90 days, respectively. One patient died of massive abdominal bleeding secondary to Gastroduodenal artery pseudoaneurysm rupture, the other patient died of extensive tumor recurrence and metastasis after surgery. Conclusions: Chen's pancreaticojejunostomy technique is safe and feasible for LPD.It is an option especially for surgeons who have not completed the learning curve of LPD.


Assuntos
Laparoscopia , Neoplasias Pancreáticas , Pancreaticoduodenectomia , Pancreaticojejunostomia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Fístula Pancreática/etiologia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/métodos , Pancreaticojejunostomia/métodos , Complicações Pós-Operatórias , Estudos Retrospectivos
3.
J Surg Oncol ; 121(5): 881-892, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31994193

RESUMO

Neoadjuvant treatment (NT) for pancreatic head cancer may allow some patients to undergo curative resection, but its impact on postoperative complications remains unclear. A systematic review and meta-analysis were performed to compare overall postoperative morbidity, pancreatic fistula, and mortality between patients who underwent upfront surgery and those who underwent neoadjuvant therapy first. Forty-five studies with 3359 patients were included. No significant differences in morbidity and mortality rates associated with NT for pancreatic head cancer were detected in this study.


Assuntos
Adenocarcinoma/terapia , Terapia Neoadjuvante , Neoplasias Pancreáticas/terapia , Complicações Pós-Operatórias , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Quimioterapia Adjuvante , Humanos , Fístula Pancreática/etiologia , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Radioterapia Adjuvante
4.
J Surg Res ; 246: 315-324, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-29754962

RESUMO

BACKGROUND: Postoperative pancreatic fistula (POPF) is a potentially debilitating complication following pancreatoduodenectomy (PD). There are limited data correlating pancreatic parenchymal histopathologic features specifically fat and fibrosis content with development of POPF after PD. METHODS: Patients who underwent PD (January 2010-May 2015) with archived pathologic slides were included. Each pancreatic neck transection margin was histologically graded for fat and fibrosis, scored from 0 to 4, and grader was blinded to clinical outcomes. Main pancreatic duct diameter and duct wall thickness were microscopically measured. Patients were dichotomized into high and low categories with respect to pancreatic fat and fibrosis and primary outcome of POPF. RESULTS: Of 301 patients, 24 developed POPF (8.0%). One hundred ten patients (36.5%) had low fat (score <2), and 149 (49.5%) had low fibrosis (score <2), and average duct diameter was 3.9 ± 1.3 mm. Patients with low fibrosis had a higher rate of POPF (12.8% versus 3.3%, P = 0.005). Low fibrosis (odds ratio [OR] 4.29, 95% confidence interval [CI] 1.56-11.7, P = 0.005), nonpancreatic adenocarcinoma pathology (OR 3.25, 95% CI 1.25-8.43, P = 0.02), and increased body mass index (BMI) (OR 1.11, 95% CI 1.03-1.12, P = 0.007) were associated with POPF development on univariate analysis. Low fibrosis and increased BMI remained independently associated on multivariate analysis. High fat content was frequently concurrently identified in specimens with high fibrosis (67.8%). Surgeon-described gland consistency did not correlate with histopathologic findings (Spearman's rank correlation coefficients of -0.144 and 0.304, respectively) or to incidence of POPF. No patient who underwent preoperative chemotherapy developed POPF (n = 30, 10%). CONCLUSIONS: Low pancreatic neck fibrosis content and increased patient BMI are associated with increased rates of POPF following PD, while pancreatic fat content does not appear to influence this outcome. Pancreatic neck fat and fibrosis often coexist in the same specimen. The association between preoperative chemotherapy and low POPF rates needs further examination. Frozen section analysis of pancreatic neck margin for fibrosis content may be more accurate than surgeon assessment in identifying patients at risk for POPF. These assessments can potentially guide therapeutic interventions, including selective prophylactic drain placement and use of postoperative somatostatin analog therapy.


Assuntos
Carcinoma Ductal Pancreático/cirurgia , Pâncreas/patologia , Fístula Pancreática/epidemiologia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Idoso , Carcinoma Ductal Pancreático/patologia , Feminino , Fibrose , Secções Congeladas , Humanos , Incidência , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Pâncreas/cirurgia , Fístula Pancreática/etiologia , Neoplasias Pancreáticas/patologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco/métodos
5.
Int J Surg ; 73: 72-77, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31843679

RESUMO

BACKGROUND: Postoperative pancreatic fistula (POPF) remains a major cause of morbidity following pancreaticoduodenectomy (PD). This network meta-analysis (NMA) compared techniques of pancreatic anastomosis following PD to determine the technique with the best outcome profile. METHODS: A systematic literature search was performed on the Scopus, EMBASE, Medline and Cochrane databases to identify RCTs employing the international study group of pancreatic fistula (ISGPF) definition of POPF. The primary outcome was clinically relevant POPF. RESULTS: Five techniques of pancreatic anastomosis following PD were directly compared in 15 RCTs comprising 2428 patients. Panreatojejunostomy (PJ) end-to-side invagination vs. PJ end-to-side duct-to-mucosa was the most frequent comparison (n = 7). Overall, 971 patients underwent PJ end-to-side duct-to-mucosa, 791 patients PJ end-to-side invagination, 505 patients pancreatogastrostomy (PG) end-to-side invagination, 98 patients PG end-to-side duct-to-mucosa, and 63 patients PJ end-to-side single layer. PG duct-to-mucosa was associated with the lowest rates of clinically relevant POPF, delayed gastric emptying, intra-abdominal abscess, all postoperative morbidity and postoperative mortality, the shortest operative time and postoperative hospital stay and the lowest volume of intra-operative blood loss. CONCLUSION: Duct-to-mucosa pancreaticogastrostomy was associated with the lowest rates of clinically relevant POPF and had the best outcome profile among all techniques of pancreatico-anastomosis following PD.


Assuntos
Jejuno/cirurgia , Pâncreas/cirurgia , Fístula Pancreática/etiologia , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Estômago/cirurgia , Anastomose Cirúrgica/métodos , Feminino , Gastrostomia/métodos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Metanálise em Rede , Duração da Cirurgia , Fístula Pancreática/epidemiologia , Pancreaticojejunostomia/métodos , Complicações Pós-Operatórias/epidemiologia
6.
Anticancer Res ; 39(12): 6799-6806, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810945

RESUMO

BACKGROUND/AIM: In order to overcome postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP), we have developed a new simple technique-Clip on Staple method. PATIENTS AND METHODS: In Clip on Staple method, pancreatic parenchyma was divided using a stapling device with a stepped-height staple design to make linear compression line, and thereafter, the full length of the staple line was reinforced by multiple clips. Clinical outcomes were retrospectively compared between Clip on Staple group (n=23) and Non-Clip group (n=38). RESULTS: The incidence of clinically relevant POPF (CR-POPF) was significantly lower in the Clip on Staple group than in the Non-Clip group (4.3 and 36.8%, p=0.005). Multivariate logistic regression analysis revealed that only Clip on Staple method was an independent predictive factor of a decrease in the occurrence of CR-POPF. CONCLUSION: The Clip on Staple method, a simple and easily applicable technique even in laparoscopic surgery, significantly reduced the occurrence of CR-POPF among patients undergoing DP.


Assuntos
Pâncreas/cirurgia , Pancreatectomia/efeitos adversos , Fístula Pancreática/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Instrumentos Cirúrgicos , Grampeamento Cirúrgico/métodos , Idoso , Feminino , Humanos , Incidência , Laparoscopia , Masculino , Pancreatectomia/métodos , Fístula Pancreática/epidemiologia , Fístula Pancreática/etiologia , Complicações Pós-Operatórias/etiologia , Análise de Regressão
7.
Georgian Med News ; (295): 17-20, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31804192

RESUMO

Our purpose was to determine the incidence of pancreatic fistula (POPF) and delayed gastric emptying (DGE), assess impact of these and other potential factors of influence on overall survival. We analyzed 97 patients who underwent pancreaticoduodenectomy between 2012 and 2018 years. POPF grade B was present in 7 (7,1%) and grade C in 8 (8,2%). DGE grade B was present in 15 (15,3%) and grade C in 7 (7,1%). Patients with POPF grade C had lower OS, compared to others (p=0,0005). DGE had a significant association with POPF (χ²=9,5; p=0,003). Furthermore, we didn't prove impact of DGE grade, grade of tumor differentiation, T and N status, histological subtype (adenocarcinomas vs. other types) on OS (р=0,63, p=0,1054, p=0,7, p=0,74 and p=0,193 respectively). Therefore, POPF, especially grade C, is accompanied by a decrease in OS of patientsafter PD and is associated with DGE. DGE, tumor differentiation, T and N indices, and histological type of the tumor have no influence on OS.


Assuntos
Gastroparesia , Fístula Pancreática , Pancreaticoduodenectomia , Gastroparesia/etiologia , Humanos , Fístula Pancreática/etiologia , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
8.
Curr Med Sci ; 39(6): 1009-1018, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31845235

RESUMO

Pancreatic fistula (PF) remains the most frequent complication after pancreaticoduodenectomy (PD). This study was undertaken to explore the risk factors of postoperative PF following PD and discuss the management of PF in our center. A single-center respective study, involving 241 patients who underwent PD between September 2015 and June 2018, was conducted. Differences in the demographic data, preoperative, intraoperative and postoperative variables between the group with PF [International Study Group on Pancreatic Surgery (ISGPS) grade B/C] and the group without PF (no PF and ISGPS grade BL) were evaluated. The diagnosis and grading of PF were in strict accordance with ISGPS. Risk factors were analyzed by univariate analysis and multivariate logistic regression analysis. The results showed that postoperative PF occurred in 50 (20.7%) of the patients; 25 (10.4%) patients had a PF type BL, 46 (19.1%) patients developed a PF type B and 4 (1.6%) had a PF type C. Univariate analysis showed that fasting blood glucose (P=0.02), pancreatic texture (P< 0.001) and pancreatic duct diameter (P=0.01) were correlated with PF. Multivariate logistic regression analysis identified one independent risk factor for postoperative PF: soft pancreatic texture (OR=3.251, P=0.002). Among the cases, there were three postoperative deaths, giving a 60-day hospital mortality rate of 1.2% (3/241), and the mortality related to PF was 4.0% (2/50). One of the patients died from multiple organ failure caused by postoperative abdominal hemorrhage. In conclusion, soft pancreatic texture is an independent risk factor for PF. Surgeons should be well aware of this risk factor when performing a PD.


Assuntos
Fístula Pancreática/epidemiologia , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fístula Pancreática/etiologia , Fístula Pancreática/mortalidade , Complicações Pós-Operatórias/mortalidade , Medição de Risco , Análise de Sobrevida
9.
Anticancer Res ; 39(11): 6283-6290, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704858

RESUMO

BACKGROUND/AIM: The usefulness of C-reactive protein-to-albumin ratio (CAR) as a predictive indicator for clinically-relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD) is unclear. We performed a retrospective analysis to identify reliable inflammatory indicators for prediction of CR-POPF after PD. PATIENTS AND METHODS: We enrolled 160 consecutive patients who underwent PD. Multivariate logistic regression analysis was performed. The areas under curves (AUCs) were compared with the discriminatory ability of inflammatory indicators, namely, C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet count multiplied by C-reactive protein (P-CRP), and CAR. RESULTS: The AUC for CAR on POD 3 to predict CR-POPF was 0.782 (p<0.001) and higher than that for CRP (0.773), NLR (0.652), PLR (0.504), and P-CRP (0.703). Multivariate analysis revealed that CAR on POD 3 was an independent predictive indicator of CR-POPF. CONCLUSION: CAR on POD 3 is a reliable predictor of CR-POPF after PD.


Assuntos
Proteína C-Reativa/análise , Fístula Pancreática/sangue , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias/sangue , Albumina Sérica/análise , Idoso , Amilases/análise , Biomarcadores/sangue , Feminino , Humanos , Modelos Logísticos , Contagem de Linfócitos , Masculino , Neutrófilos/citologia , Pâncreas/patologia , Ductos Pancreáticos/patologia , Fístula Pancreática/diagnóstico , Fístula Pancreática/etiologia , Contagem de Plaquetas , Complicações Pós-Operatórias/diagnóstico , Curva ROC , Estudos Retrospectivos
10.
Am Surg ; 85(11): 1239-1245, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775965

RESUMO

The purpose of this meta-analysis was to compare the clinical outcomes of central pancreatectomy (CP) with distal pancreatectomy (DP). PubMed, Web of Knowledge, and Ovid's database were searched for studies published in English language between January 1990 and December 2018. A meta-analysis was performed to compare the clinical outcomes of CP versus DP. Nineteen trials with 1440 patients were analyzed. Although there were no significant differences in the rate of intraoperative blood transfusion between two groups, CP costs more operative time as well as had more intraoperative blood loss than DP. Furthermore, the overall complication rate, pancreatic fistula rate, and the clinically significant pancreatic fistula rate were significantly higher in the CP group. On the other hand, CP had a lower risk of endocrine (odds ratio: 0.17; 95% confidence interval: 0.10, 0.29; P < 0.05) and exocrine insufficiency (odds ratio: 0.22; 95% confidence interval: 0.10, 0.48; P < 0.05). CP was associated with a higher pancreatic fistula rate, and it should be performed in selected patients who need preservation of the pancreas, which is of utmost importance.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Duração da Cirurgia , Pancreatectomia/efeitos adversos , Pancreatectomia/métodos , Fístula Pancreática/etiologia , Neoplasias Pancreáticas/cirurgia , Complicações Pós-Operatórias/etiologia , Transfusão de Sangue/estatística & dados numéricos , Intervalos de Confiança , Diabetes Mellitus/etiologia , Humanos , Tempo de Internação , Resultado do Tratamento
11.
Cir. Esp. (Ed. impr.) ; 97(9): 501-509, nov. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-187626

RESUMO

Introducción: La mortalidad postoperatoria asociada a la duodenopancreatectomía (DP) en centros de alto volumen es inferior al 5%, sin embargo, las tasas de morbilidad oscilan entre el 45% y el 60%. Estudios recientes muestran una menor incidencia de complicaciones y fístula pancreática postoperatoria (POPF) con el uso de la pancreaticogastrostomía (PG). El objetivo de nuestro estudio es evaluar la incidencia y los factores predictivos de las complicaciones: POPF, hemorragia pospancreatectomía y retraso del vaciamiento gástrico según los criterios de las clasificaciones ISGPS y Clavien-Dindo. Material y métodos: Estudio prospectivo observacional en el que se incluyeron todos los pacientes sometidos a DP entre 2008 y 2016. La PG fue la técnica de elección en la reconstrucción de la DP. Resultados. Doscientos cuarenta y nueve pacientes se sometieron a cirugía con la intención de realizar una DP. La viabilidad de PG fue del 90,5%. Ciento seis (53%) pacientes tuvieron complicaciones, 36 (18%) fueron graves (grado Clavien-Dindo ≥ III). La mortalidad a 90 días fue del 4%. El retraso del vaciamiento gástrico fue la complicación más frecuente (22,5%), seguida de la hemorragia pospancreatectomía (21%). La tasa clínica de POPF fue del 15% (6% grado Clavien-Dindo ≥ III). Los principales factores de riesgo asociados a las complicaciones fueron la edad > 70 años (1,9 [1-3,55]), el sexo masculino (1,89 [1; 3,6]) y la textura blanda del páncreas (3,38 [1,5; 7,37]). Conclusiones: En nuestra experiencia la factibilidad de la PG fue del 90,5%. Los principales factores de riesgo asociados a las complicaciones fueron la edad > 70 años, el sexo masculino y la textura blanda del páncreas. La textura blanda del páncreas también está asociada al desarrollo y la gravedad de la POPF


Background: Postoperative mortality associated with pancreaticoduodenectomy (PD) in high-volume hospitals is below 5%, yet morbidity rates range between 45% and 60%. Recent studies show a lower incidence of complications and postoperative pancreatic fistula (POPF) in pancreaticogastrostomy (PG). The primary objective was to assess the incidence and predictive factors for complications: POPF, post-pancreatectomy hemorrhage (PPH) and delayed gastric emptying (DGE) following the criteria of the ISGPS and Clavien-Dindo classifications. Methods: A prospective observational study that included all patients who underwent PD between 2008 and 2016. PG was the surgical procedure of choice for PD reconstruction. Results: Two hundred forty-nine patients underwent surgery with intention of performing a PD. The feasibility of PG was 90.5%. One hundred and six (53%) patients had complications, 36 (18%) were severe (Clavien-Dindo grade ≥ III). Death within 90 postoperative days was 4%. DGE was the most frequent complication (22.5%), followed by PPH (21%). The clinical POPF rate was 15% (6% Clavien-Dindo grade ≥ III). The primary risk factors associated with complications were age > 70 years (1.9 [1-3.55]), being male (1.89 [1; 3.6]) and soft pancreatic texture (3.38 [1.5; 7.37]). Conclusions: In this paper, we report a feasibility study for PG (90.5%). The primary risk factors associated with complications were age > 70 years, being male and soft pancreatic texture. Soft pancreatic texture is also associated with the development and severity of POPF


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Gastrostomia/mortalidade , Pâncreas/cirurgia , Fístula Pancreática/etiologia , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Fatores Etários , Incidência , Morbidade , Pâncreas/patologia , Complicações Pós-Operatórias/mortalidade , Hemorragia Pós-Operatória/epidemiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Estudos de Viabilidade
12.
Khirurgiia (Mosk) ; (9): 93-98, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31532174

RESUMO

OBJECTIVE: To improve short- and long-term outcomes of locally advanced pancreatic body-tail cancer followed by major vessels invasion. MATERIAL AND METHODS: A case report of pure laparoscopic DP-CAR procedure with portal vein resection for locally advanced pancreatic body-tail cancer followed by severe abdominal pain in a 49-year-old patient is presented. RESULTS: Liver or stomach ischemia was not observed. Portal wall resection wasn't associated with any complication and resulted R0-resection. Postoperative period was complicated by Grade B pancreatic fistula. Preoperative abdominal pain completely disappeared after surgery. Surgery time was 330 min, intraoperative blood loss - 300 ml. The patient is currently undergoing FOLFIRINOX adjuvant chemotherapy. CT in 90 days after surgery confirmed no progression of disease or liver/stomach blood supply congestion. CONCLUSION: Modern technologies provide the opportunity to perform pure laparoscopic advanced surgical procedures with major vessels resection. Pure laparoscopic DP-CAR procedure with portal vein resection is effective and safe procedure that can be performed with all principles of open surgery and is associated with acceptable short- and long-term results.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Artéria Celíaca/cirurgia , Laparoscopia/métodos , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Veia Porta/cirurgia , Antineoplásicos/administração & dosagem , Fluoruracila/administração & dosagem , Humanos , Irinotecano/administração & dosagem , Leucovorina/administração & dosagem , Pessoa de Meia-Idade , Invasividade Neoplásica , Oxaliplatina/administração & dosagem , Pancreatectomia/efeitos adversos , Fístula Pancreática/etiologia , Neoplasias Pancreáticas/patologia , Veia Porta/patologia
13.
Zhonghua Wai Ke Za Zhi ; 57(10): 31-37, 2019 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-31510730

RESUMO

Objective: To examine the association of hyperglycemia and postoperative complications in non-diabetic patients underwent pancreaticoduodenectomy(PD). Methods: The clinical data of 209 non-diabetic patients who underwent PD from January 2012 to June 2018 at Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University and met the inclusion criteria were retrospectively analyzed. According to the diagnostic criteria of postoperative hyperglycemia, the patients were divided into postoperative hyperglycemia group (167 cases, 79.9%) and control group(42 cases, 20.1%). The propensity score matching(PSM) method was used to eliminate the difference between groups(caliper value=0.02; 38 cases in control group including 30 males and 8 females with age of 59.0 years;38 cases in postoperative hyperglycemia group including 32 males and 6 females with age of 61.0 years;37 cases of pancreatic head carcinoma,30 cases of periampullary carcinoma and 9 cases of benign diseases). A comparative analysis was applied for preoperative data, surgical related indicators and postoperative complication rates.The receiver operating characteristic(ROC) curve was used to calculate the area under the curve(AUC) of blood glucose values on postoperative day 1,3 and 5(POD1, POD3, POD5), to determine the high-risk blood glucose cutoff value of complications and to evaluate its sensitivity and specificity for the prediction of postoperative complications. Results: Univariate analysis showed that the differences in gender, body mass index, preoperative blood glucose, and serum urea nitrogen levels were statistically significant before PSM.There was no significant difference in the preoperative data between the two groups after PSM. Compared with the control group, the incidence of postoperative pancreatic fistula (31.6% vs. 5.3%), abdominal infection(29.0% vs. 7.9%) and Clavien-Dindo Ⅲ-Ⅴ complications(31.6% vs.7.9%) were statistically different(χ(2)=7.092,P=0.008; χ(2)=4.290,P=0.038; χ(2)=5.316,P=0.021), respectively. According to the AUC on POD3,the blood glucose value ≥8.860 mmol/L was an independent risk factor for pancreatic fistula with sensitivity of 58.3% and specificity of 76.9%,the blood glucose value ≥9.130 mmol/L was an independent risk factor for abdominal infection with sensitivity of 54.5% and specificity of 81.5% and the blood glucose value ≥7.685 mmol/L was independent risk factor of Clavien-Dindo Ⅲ-Ⅴ complications with sensitivity of 75.0% and specificity of 57.7%. Conclusions: Postoperative hyperglycemia in non-diabetic patients is associated with postoperative pancreatic fistula, abdominal infection, and Clavien-Dindo Ⅲ-Ⅴ complications.According to the early postoperative blood glucose value,the occurrence of postoperative pancreatic fistula, abdominal infection and Clavien-Dindo Ⅲ- Ⅴ complications can be effectively predicted.


Assuntos
Hiperglicemia/complicações , Pancreaticoduodenectomia/efeitos adversos , Feminino , Humanos , Hiperglicemia/sangue , Infecções Intra-Abdominais/etiologia , Masculino , Pessoa de Meia-Idade , Pancreatopatias/cirurgia , Fístula Pancreática/etiologia , Complicações Pós-Operatórias/classificação , Valor Preditivo dos Testes , Estudos Retrospectivos
14.
Surg Oncol ; 30: 76-80, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31500790

RESUMO

BACKGROUND: The use of intraperitoneal drainage after distal pancreatectomy is still controversial. Its use increases fistula risk, but its absence increases the severity of the fistula. Therefore, since 2014, we have systematically used two drains. METHODS: This study examined consecutive patients undergoing distal pancreatectomy with splenectomy. Two drains were routinely used. One closed-suction-type drain is placed in the left subphrenic space with the aim to avoid the accumulation of any fluid coming from the pancreatic stump. The second is a tubulo-laminar drain placed near the pancreatic stump. These patients were compared with a cohort of patients (n = 94) before the adoption of this strategy (control group). RESULTS: 127 patients underwent distal pancreatectomy. 48 patients presented no POPF, 60 patients presented biochemical leak and in 19 patients (14.9%), drain amylase level was high and the drain was removed at 4 weeks, classified as grade-B according to the Revised 2016 ISGPS or B1 according to grade-B subclass. No grade-C was observed. The comparison with the 94 patients in the control group with single drainage, the occurrence of POPF was not different. However, in the control group, POPF severity was statistically higher (grade-B 14.9% vs 33%; grade-C 0% vs 3,2%; P = 0.00026). CONCLUSIONS: Since changing the drainage strategy, we have observed a dramatic decrease in pancreatic abscess formation and fluid collections needing percutaneous drainage. The results of this study show that the strategy of double drainage after distal pancreatectomy may reduce the severity of POPF, thus avoiding reoperation or further interventions.


Assuntos
Drenagem/estatística & dados numéricos , Pancreatectomia/métodos , Fístula Pancreática/diagnóstico , Neoplasias Pancreáticas/cirurgia , Complicações Pós-Operatórias , Medição de Risco/métodos , Índice de Gravidade de Doença , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Criança , Drenagem/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fístula Pancreática/etiologia , Neoplasias Pancreáticas/patologia , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Esplenectomia/métodos , Adulto Jovem
15.
Zhonghua Wai Ke Za Zhi ; 57(9): 654-659, 2019 Sep 01.
Artigo em Chinês | MEDLINE | ID: mdl-31474056

RESUMO

Objective: To analyze the risk factors for biochemical leak progressing to grade B pancreatic fistula after pancreaticoduodenectomy(PD) early. Methods: Retrospective analysis was conducted in the whole clinical data of 190 patients who had incurred biochemical leak from November 2014 to April 2017 at the First Hospital of China Medical University.There were 112 males and 78 females, aging of (73±6) years(range:22 to 77 years).And all the potential factors for progressing from biochemical leak to grade B were analyzed with univariate and logistic regression multivariate model. These statistically significant preoperative indicators which enabled the plotting of the receiver operation characteristic(ROC) curves were selected for plotting the ROC curves, calculating the area under the curve(AUC) and evaluating the forecast values. With pertinence to indicators with the forecast values above the medium level, the maximum predictive performance of the critical value was determined by using the different cut-off values to calculate the Youden index and other indicators. Results: Among the 190 cases of PD patients, there were 81 cases had incurred biochemical leak including 36 cases with no progression, 41 cases progressing to grade B and 4 cases progressing from grade B to grade C.Univariate analysis showed CT value of pancreatic body, acute pancreatitis preoperatively, and the platelet(PLT), prealbumin, ALT on postoperative 3-4 days were risk factors for progressing from biochemical leak to grade B. Multivariate analysis showed CT value, acute pancreatitis preoperatively, and the PLT on postoperative 3-4 days were independent risk factors. Postoperatively patients with biochemical leak got acute pancreatitis before surgery were more likely to progress to grade B as well as those with the lower CT value before surgery or the lower PLT at 3-4 days after surgery. The AUC of CT value was 0.734. Using 39.8 HU as CT value, the sensitivity, specificity and Youden index were 73.2%, 75.0% and 0.482, with the highest performance prediction. Conclusion: The analysis of CT value of pancreatic body for standardized judgment of pancreas texture, the rational treatments of acute pancreatitis preoperatively and appropriate administration of patients with platelet-related drugs during perioperative period can respectively forecast and prevent progressing from biochemical leak to grade B.


Assuntos
Fístula Anastomótica/etiologia , Pancreatopatias/cirurgia , Fístula Pancreática/etiologia , Pancreaticoduodenectomia/efeitos adversos , Doença Aguda , Adulto , Idoso , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatopatias/complicações , Pancreatite/complicações , Pancreatite/cirurgia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
16.
World J Gastroenterol ; 25(28): 3722-3737, 2019 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-31391768

RESUMO

Postoperative pancreatic fistula (POPF) is one of the most severe complications after pancreatic surgeries. POPF develops as a consequence of pancreatic juice leakage from a surgically exfoliated surface and/or anastomotic stump, which sometimes cause intraperitoneal abscesses and subsequent lethal hemorrhage. In recent years, various surgical and perioperative attempts have been examined to reduce the incidence of POPF. We reviewed several well-designed studies addressing POPF-related factors, such as reconstruction methods, anastomotic techniques, stent usage, prophylactic intra-abdominal drainage, and somatostatin analogs, after pancreaticoduodenectomy and distal pancreatectomy, and we assessed the current status of POPF. In addition, we also discussed the current status of POPF in minimally invasive surgeries, laparoscopic surgeries, and robotic surgeries.


Assuntos
Pancreatectomia/métodos , Fístula Pancreática/prevenção & controle , Pancreaticoduodenectomia/métodos , Pancreaticojejunostomia/métodos , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/prevenção & controle , Drenagem/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Laparoscopia/métodos , Pâncreas/efeitos dos fármacos , Pâncreas/patologia , Pâncreas/cirurgia , Pancreatectomia/efeitos adversos , Pancreatectomia/instrumentação , Fístula Pancreática/epidemiologia , Fístula Pancreática/etiologia , Suco Pancreático/efeitos dos fármacos , Suco Pancreático/metabolismo , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/instrumentação , Pancreaticojejunostomia/efeitos adversos , Pancreaticojejunostomia/instrumentação , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Somatostatina/análogos & derivados , Somatostatina/uso terapêutico , Stents/efeitos adversos , Resultado do Tratamento
17.
J Cancer Res Ther ; 15(4): 857-863, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31436243

RESUMO

Purpose: Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is a worrisome and life-threatening complication. This study aimed to investigate the risk factors and preventive strategies for POPF after PD. Materials and Methods: We retrospectively reviewed 301 consecutive patients who underwent PD at our hospitals between January 2011 and December 2017. We analyzed the pancreatic fistula rate according to the clinical characteristics, pathologic and laboratory findings, and the anastomotic methods and summarized the prevention measures. Results: Postoperative morbidities included pancreatic leakage in 10.30% (31/301), delayed gastric emptying in 22.92% (69/301), abdominal infection in 6.98% (21/301), post-PD hemorrhage in 4.65% (14/301), and bile leakage in 4.98% (15/301), and the mortality rate was 2.33% (7/301). POPF was the most prominent factor for preoperative morbidity. Significant risk factors for pancreatic fistula were a soft pancreas, small pancreatic duct, tumor location, and interrupted anastomosis. Of these, soft texture, pancreatic duct <4 mm, and end-to-end anastomosis through hand suture closure were independent risk factors on multivariate analysis, while interrupted anastomosis, internal stent, and somatostatin use were risk factors in the high-risk pancreas subgroup. Conclusions: Our study demonstrated that pancreatic fistula is related to a soft texture and small pancreatic duct. The surgeon must consider these risk factors when performing PD. Thus, we propose a risk- and indication-adapted choice of anastomosis or an individualized approach for the pancreatic remnant to reduce the pancreatic fistula rate.


Assuntos
Neoplasias Duodenais/cirurgia , Fístula Pancreática/etiologia , Fístula Pancreática/prevenção & controle , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Carcinoma Ductal Pancreático/patologia , Carcinoma Ductal Pancreático/cirurgia , Neoplasias Duodenais/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/patologia , Prognóstico , Estudos Retrospectivos , Adulto Jovem
18.
BMC Surg ; 19(1): 108, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409334

RESUMO

OBJECTIVE: We aimed to determine the impact of surgical experience and frequency of practice on perioperative morbidity and mortality in pancreatic surgery. METHODS: 1281 patients that underwent pancreatic resections from 1993 to 2013 were retrospectively analyzed using logistic regression models. All cases were stratified according to the surgeon's level of experience, which was based on the number of previously performed pancreatic resections and the extent of received supervision (novice: n <  20 / intensive; intermediate: n = 21-90 / decreasing; and experienced surgeon: n > 90 / none). Additional stratification was based on the frequency of practice (sporadic: 3 resections > 6 weeks, frequent: 3 resections ≤6 weeks). RESULTS: The novice and experienced categories were related to a decreased risk of postoperative pancreatic fistulas (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.26-0.82 and 0.54, 95% CI 0.36-0.82) and in-hospital mortality (OR 0.45, 95% CI 0.17-1.16 and 0.42, 95% CI 0.21-0.83) compared to the intermediate category. Frequent practice was associated with a significantly lower risk of delayed gastric emptying (OR 0.56, 95% CI 0.38-0.83), postpancreatectomy hemorrhage (OR 0.64, 95% CI 0.42-0.98) and in-hospital mortality (OR 0.45, 95% CI 0.24-0.87). CONCLUSIONS: Our results emphasize the importance of supervision within a pancreatic surgery training program. In addition, our data underline the need of a sufficient patient caseload to ensure frequent practice.


Assuntos
Competência Clínica , Pancreatectomia/efeitos adversos , Idoso , Feminino , Gastroparesia/etiologia , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pancreatectomia/métodos , Pancreatectomia/mortalidade , Fístula Pancreática/etiologia , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos
19.
Expert Rev Gastroenterol Hepatol ; 13(8): 797-806, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31282769

RESUMO

Introduction: Postoperative pancreatic fistula is the most troublesome complication after pancreaticoduodenectomy, and is an on-going area of concern for pancreatic surgeons. The specific pancreatic reconstruction technique is an important factor influencing the development of postoperative pancreatic fistula after pancreaticoduodenectomy. Areas covered: In this paper, we briefly introduced the definition and relevant influencing factors of postoperative pancreatic fistula. We performed a search of all meta-analyses published in the last 5 years and all published randomized controlled trials comparing different pancreatic anastomotic techniques, and we evaluated the advantages and disadvantages of different techniques. Expert opinion: No individual anastomotic method can completely avoid postoperative pancreatic fistula. Selecting specific techniques tailored to the patient's situation intraoperatively may be key to reducing the incidence of postoperative pancreatic fistula.


Assuntos
Jejuno/cirurgia , Pâncreas/cirurgia , Fístula Pancreática/etiologia , Pancreaticoduodenectomia/efeitos adversos , Estômago/cirurgia , Anastomose Cirúrgica , Humanos , Fístula Pancreática/diagnóstico , Fístula Pancreática/cirurgia , Pancreaticoduodenectomia/métodos , Fatores de Risco
20.
Zhonghua Wai Ke Za Zhi ; 57(7): 534-539, 2019 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-31269617

RESUMO

Objective: To investigate the prognostic factors of hyperamylasemia following pancreaticoduodenectomy (PD) . Methods: Clinical data of 359 patients were collected prospectively who underwent PD by the same group at Changhai Hospital of Navy Medical University from January 2017 to June 2018.There were 212 males and 147 females.The median age was 63 years old (range: 23 to 82 years old) .According to whether the patient's serum amylase was greater than 120 U/L at 0 or 1 day after surgery,the patients were divided into hyperamylasemia group and non-hyperamylasemia group. Univariate analysis and multivariate analysis were used to find out the prognostic factors of hyperamylasemia after PD. Results: Of the 359 patients, 238 cases (66.3%) developed hyperamylasemia.The incidence rate of clinically related pancreatic fistula (15.1% vs.2.5%, P<0.01) , grade B/C post pancreatectomy hemorrhage (8.8% vs. 2.5%, P<0.01) , and surgical site infection (9.2% vs. 3.3%, P=0.04) was significantly higher in the hyperamylasemia group.The severity of complications (CD grade≥Ⅲ: 11.3% vs.4.1%, P=0.023) and postoperative hospital stay (11 days vs. 9 days, P=0.001) were higher in the hyperamylasemia group.In the multivariate analysis, the main pancreatic duct diameter (MPD) ≤3 mm (OR=4.469, 95% CI: 2.563-7.793, P<0.01) , pathological type of disease (pancreatic cancer or pancreatitis) (OR=0.230, 95% CI: 0.122-0.436, P<0.01) and soft texture of pancreas (OR=3.297, 95%CI: 1.930-5.635, P<0.01) were independent prognostic factors for hyperamylasemia. Conclusions: Post-PD hyperamylasemia increased the incidence and severity of postoperative complications after PD.MPD≤3 mm, soft texture of pancreas and pathological type of disease were independent prognostic factors of hyperamylasemia.


Assuntos
Hiperamilassemia/etiologia , Pancreatopatias/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Amilases/sangue , Feminino , Hemorragia/sangue , Hemorragia/etiologia , Humanos , Hiperamilassemia/sangue , Masculino , Pessoa de Meia-Idade , Pancreatopatias/sangue , Pancreatopatias/etiologia , Fístula Pancreática/sangue , Fístula Pancreática/etiologia , Pancreaticoduodenectomia/métodos , Prognóstico , Fatores de Risco , Infecção da Ferida Cirúrgica/sangue , Infecção da Ferida Cirúrgica/etiologia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA