What Factors Contribute to Delayed Gastric Emptying After Duodenopancreatectomy With Piloric Preservation?

Nishio, Ricardo Tadashi; Pacheco, Adhemar Monteiro; Moricz, André de; Silva, Rodrigo Altenfelder

doi:10.1590/0102-672020210002e1592

Cited by 5 publications

(1 citation statement)

References 27 publications

(35 reference statements)

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“…The more common complications include delayed gastric emptying, postoperative pancreatic fistula, postoperative bleeding, and infectious complications 14 . Delayed gastric emptying is a frequent complication after pancreatoduodenectomy and it is associated with prolonged hospital stay and high costs, even with the low mortality rate resulting from it 10 . Chylous ascites is a rare form of ascites resulting from the leakage of lipid-rich intestinal lymph into the peritoneal cavity and may be an iatrogenic postoperative complication 2,7,12 .…”

Section: Discussionmentioning

confidence: 99%

Lipiodol Lymphangiography and Embolization of Chylous Ascites After Pancreatoduodenectomy

Torres

Valleta

Moraes-Junior

et al. 2022

ABCD, arq. bras. cir. dig.

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Section: Discussionmentioning

confidence: 99%

Lipiodol Lymphangiography and Embolization of Chylous Ascites After Pancreatoduodenectomy

Torres

Valleta

Moraes-Junior

et al. 2022

ABCD, arq. bras. cir. dig.

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Delayed gastric emptying after pancreatoduodenectomy: an analysis of risk factors

Sabogal,

Conde Monroy,

Rey Chaves

et al. 2024

Updates Surg

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Background Delayed gastric emptying (DGE) is a frequent complication after pancreatoduodenectomy. Preoperative factors are limited and controversial. This study aims to identify associated factors related to this complication in the Colombian population. Methods A retrospective review of a prospectively collected database was conducted. All patients over 18 years of age who underwent pancreaticoduodenectomy were included. Associations with DGE syndrome were evaluated with logistic regression analysis, Odds ratio, and b-coefficient were provided when appropriate. Results 205 patients were included. Male patients constituted 54.15% (n = 111). 53 patients (25.85%) were diagnosed with DGE syndrome. Smoking habit (OR 17.58 p 0.00 95% CI 7.62–40.51), hydromorphone use > 0.6 mg/daily (OR 11.04 p 0.03 95% CI 1.26–96.66), bilirubin levels > 6 mg/dL (OR 2.51 p 0.02 95% CI 1.12–5.61), and pancreatic fistula type B (OR 2.72 p 0.02 CI 1.74–10.00). Discussion Smoking history, opioid use (hydromorphone > 0.6 mg/Daily), type B pancreatic fistula, and bilirubin levels > 6 mg/dL should be considered as risk factors for DGE.

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Development and validation of a novel nomogram to predict postoperative pancreatic fistula after pancreatoduodenectomy using lasso-logistic regression: an international multi-institutional observational study

Gu,

Du,

Wang

et al. 2023

International Journal of Surgery

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Background: Existing prediction models for clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy lack discriminatory power or are too complex. This study aimed to develop a simple nomogram that could accurately predict clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy. Methods: A high-volume, multicenter cohort of patients who underwent pancreatoduodenectomy from the American College of Surgeons-National Surgical Quality Improvement Program database in the United States during 2014-2017 was used as the model training cohort (n=3609), and patients who underwent pancreatoduodenectomy from the Pancreatic Center of National Cancer Center Hospital in ***** during 2014-2019 were used as the external validation cohort (n=1347). The study used lasso penalized regression to screen large-scale variables, then logistic regression was performed to screen the variables and build a model. Finally, a prediction nomogram for clinically relevant postoperative pancreatic fistula was established based on the logistic model, and polynomial equations were extracted. The performance of the nomogram was evaluated by receiver operating characteristic curve, calibration curve, and decision curve analysis. Results: In the training and validation cohorts, there were 16.7% (601/3609) and 16.6% (224/1347) of patients who developed clinically relevant postoperative pancreatic fistula, respectively. After screening using Lasso and logistic regression, only 6 predictors were independently associated with clinically relevant postoperative pancreatic fistula, including 2 preoperative indicators (weight and pancreatic duct size), 1 intraoperative indicator (pancreatic texture), and 3 postoperative indicators (deep surgical site infection, delayed gastric emptying, and pathology). The prediction of the new nomogram was accurate, with an area under the curve of 0.855 (95% CI, 0.702-0.853) in the external validation cohort, and the predictive performance was superior to three previously proposed postoperative pancreatic fistula risk score models (all P<0.001, likelihood ratio test). Conclusions: A reliable Lasso-logistic method was applied to establish a novel nomogram based on 6 readily available indicators, achieving a sustained, dynamic, and precise postoperative pancreatic fistula prediction for pancreatoduodenectomy patients. With a limited number of variables and easy clinical application, this new model will enable surgeons to proactively predict, identify and manage pancreatic fistulas to obtain better outcomes from this daunting postoperative complication.

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What Factors Contribute to Delayed Gastric Emptying After Duodenopancreatectomy With Piloric Preservation?

Cited by 5 publications

References 27 publications

Lipiodol Lymphangiography and Embolization of Chylous Ascites After Pancreatoduodenectomy

Lipiodol Lymphangiography and Embolization of Chylous Ascites After Pancreatoduodenectomy

Delayed gastric emptying after pancreatoduodenectomy: an analysis of risk factors

Development and validation of a novel nomogram to predict postoperative pancreatic fistula after pancreatoduodenectomy using lasso-logistic regression: an international multi-institutional observational study

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