In our experience, LPD with concomitant major venous resection is feasible even in cases of longitudinal venous invasion. Further studies are needed to evaluate the role of laparoscopy in borderline pancreatic cancer.
The accumulation of experience performing laparoscopic procedures adopted to illustrate using the learning curve. The literature describes several models to represent the dynamics of the accumulation of experience in the evaluation of various minimally invasive procedures. However, there is no single objective method for the construction of a learning curve. To date, the learning curve for laparoscopic pancreatoduodenectomy (LDPR), one of the most complex operations in abdominal surgery, not widely described in the literature. Several models for the construction of a learning curve: a linear function and non-linear regression, exponential model, the spline regression and risk of failure coupled analysis of the cumulative sum amount. According to a graphical analysis of the learning curve LDPR ends in 47 operations.
Introduction: Laparoscopic pancreatic surgery remains one of the most difficult and challenging applications of minimally invasive surgical approaches in spite of great development of these techniques nowadays. Patients and methods: One hundred and thirty one patients with periampullar tumors that planed for laparoscopic Whipple procedure (LPD) between January 2007 and July 2015 were analyzed. In cases when the SMV/PV resection was necessary due to tumor invasion it was performed. Results: One hundred and fourteen consecutive total laparoscopic PD were successfully performed. There were 66 females and 48 males. The mean age was 61 AE 10.9 years. Median BMI 24kg/m2 (range 16 to 37 kg/m2). Fourteen patients (12%) were operated on for benign and 100 (88%) for malignant lesions. Standard Whipple (n69;60%patients), pylorus-preserving PD (n45;40%patients. Median OT was 415min (range 240e 765min). Median blood lossÀ200ml (range 50e2100 ml). Clinical significant pancreatic fistula (n20;17%patients); grade B (n14;12% patients, grade C (n6;5%patients). Delayed gastric emptying grade B (n5;4,5% patients), grade C (n5;4,5% patients) patients. Postpancreatectomy haemorrhage grade A (n2;1,7% patients), grade B (n8;7% patients, grade C (n3;2,6% patients). Pancreatic adenocarcinoma (n59;51.9%), ampullary adenocarcinoma (n27;23.9%), chronic pancreatitis (n12;10.6%), common bile duct carcinoma (n8;7.1%), IPMN (n2;1.7%), duodenal adenoma (n1;0.8%), undifferentiated cancer of pancreas (n1;0.8%), undifferentiated cancer of common bile duct (n1;0.8%), undifferentiated cancer of duodenum (n1;0.8%), neuroendocrine carcinoma (n1;0.8%), solid pseudopapillary tumor (n1;0.8%). Eight patients had different types of venous resections. Conclusion: Total LPD demands high technical skills from the whole surgical team. Morbidity and mortality are the same like in open procedures, time of the operation is higher at the initial experience and becomes practically equal after performing 50 cases. Major venous reconstruction is possible if needed.
Background: The data regarding risk factors of postoperative deep venous thrombosis (DVT) and pulmonary embolism (PE) following pancreaticoduodenectomy (PD) are limited. The purpose of this study is to identify independent risk factors of both DVT and PE in patients undergoing PD for malignancy or neoplasm. Methods: Patients who underwent PD for malignancy or neoplasm from 2010 to 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Multivariate analysis using logistic regression was used to identify independent risk factors for post-operative DVT and PE. Results: 17,742 patients underwent PD for cancer or neoplasm during this time period. Subjects were predominately white (78.4%) males (53.6%) with length of stay (LOS) of 9 (7e14) days. 30-day mortality was 1.4%. Rates of post-operative DVT and PE were 2.7% and 1.1%, respectively. Only 42 (21.5%) patients with a diagnosis of PE had concomitant DVT reported. PE was diagnosed on hospital readmission in 24 (12.3%) patients. Independent risk factors for the development of DVT were ASA score 3 (OR 1.39 [1.05e1.85]), operative time >6 hours (OR 1.47 [1.19e1.83]), LOS 1 week (OR 3.63 [2.62e5.03]), and presence of bleeding disorder (OR 2.02 [1.29e3.17]). PE was independently associated with LOS 1 week (OR 3.37 [2.08e5.47]), malignancy (OR 1.66 [1.13e2.43]), and post-operative DVT (OR 8.26 [5.56e12.23]). Overall complication rate was increased when DVT or PE occurred (OR 4.31 [3.59e 5.17] and 4.21 [3.17e5.59]). Conclusion: Multiple risk factors are independently associated with post-operative DVT and PE following PD. A majority of patients with post-operative PE did not have a preceding diagnosis of DVT. Further investigation into the routine use of DVT screening and extended chemoprophylaxis in high-risk patients should be considered.
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