Complicações após pancreatectomias: estudo prospectivo após as novas classificações GIEDFP e GIECP

Amico, Ênio Campos; Alves, José Roberto; João, Samir Assi; Guimarães, Priscila Luana Franco Costa; Barreto, Elio José Silveira da Silva; Barreto, Leonardo Silveira da Silva; Costa, Paulo Renato Leal; Medeiros, Joafran Alexandre Costa de

doi:10.1590/s0102-67202013000300011

Cited by 15 publications

(12 citation statements)

References 29 publications

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“…There was high morbidity in this series, and it was more related to the larger tumor sizes and surgery complexity than it was to the consequence of mesenteric ischemia or local technical complication from vascular reconstruction. This can be evidenced by the average operative time of 556 min, which was longer than that observed by the group in other published series of pancreaticoduodenectomies 1 . In fact, it was possible to correlate the vascular clamping as a causal factor for the development of pancreatic fistula and anastomotic bleeding in only one patient in the current study.…”

Section: Discussionmentioning

confidence: 64%

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Outcomes from mesenteric-portal axis resection during pancreatectomy

Amico

Alves

João

et al. 2014

ABCD, arq. bras. cir. dig.

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BackgroundDue to their complexity and risks, mesenteric-portal axis resection and reconstruction during the pancreatectomy procedure were not recommended back in the early nineties. However, as per technical improvements and the reduction in morbidity and mortality rates, they have been routinely indicated in large medical centers.AimTo show results from cases of patients subjected to mesenteric-portal axis resection during pancreatectomy.MethodPatients subjected to mesenteric-portal axis resection during pancreatectomy were prospectively and consecutively assessed. The procedure was indicated according to anatomical criteria defined by imaging exams or intraoperative assessment.ResultsTen patients, half of them were male, with mean age of 55.7 years (40-76) were included. The most frequent underlying diseases were pancreatic adenocarcinoma and Frantz tumor. The circumferential resection of the portal vein associated with the superior mesenteric vein with splenic vein ligature (4 cases=40%) and the primary anastomosis of the vascular stumps (5 cases=50%) were, respectively, the most performed types of vascular resection and reconstruction. Surgery time ranged from 480 to 600 minutes (average=556 minutes) and postoperative hospitalization time ranged from 9 to 114 days (average=34.8 days). Morbidity rate was 60%, and clinical pancreatic fistula (grade B and C) was the most common complication (3 cases=30%). Mortality rate was 10% (1 case).ConclusionMesenteric-portal axis resection is a valid technical procedure. It should be taken into account after a clinical assessment that included not only the patients' clinical condition but also the technical and anatomical conditions of the mesenteric-portal axis tumor infiltration as well as life expectancy based on the patient's cancer prognosis.

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Section: Discussionmentioning

confidence: 64%

“…The remaining technical steps related to pancreatic resection, transit reconstruction, cavity drainage and postoperative care were described in a previous study 1 . As for the pancreatic fistula diagnosis, it was used the criteria from the International Study Group on Pancreatic Fistula Definition 2 .…”

Section: Methodsmentioning

confidence: 99%

Outcomes from mesenteric-portal axis resection during pancreatectomy

Amico

Alves

João

et al. 2014

ABCD, arq. bras. cir. dig.

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“…Kamphues et al 14 found them in 1.4% of 442 surgically treated patients and Amico et al . 2 , in 50% of 54 surgically treated patients. Among the local factors related to the genesis of pancreatic fistulas, the consistency of the pancreatic remnant (soft, normal or hard) and the caliber of the pancreatic ducts are noteworthy.…”

Section: Discussionmentioning

confidence: 97%

“…Studies demonstrate a higher incidence of adenocarcinomas in relation to other histological types 2 and localization to the head of the pancreas 8 , 17 , 11 .…”

Section: Discussionmentioning

confidence: 99%

Morbidity and mortality of pancreatic tumors undergoing surgical treatment

Zeni¹,

Russi²,

Fialho³

et al. 2014

ABCD, arq. bras. cir. dig.

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BackgroundPancreatic cancer has a high mortality rate due to late diagnosis and aggressive behavior. The prognosis is poor, with 5-year survival occurring in less than 5% of cases.AimTo analyze demographic characteristics, comorbidities, type of procedure and early postoperative complications of patients with pancreatic cancer submitted to surgical treatment.MethodsCross-sectional study with analysis of 28 medical records of patients with malignant tumors of the pancreas in a 62 month. Data collection was performed from the medical records of the hospital.ResultsOf the total, 53,6% were male and the mean age was 60.25 years. According to the procedure, 53,6% was submitted to duodenopancreactectomy the remainder to biliodigestive derivation or distal pancreatectomy. The ductal adenocarcinoma occurred in 82,1% and 92,9% of tumors were located in the pancreatic head. Early postoperative complications occurred in 64,3% of cases and the most prevalent was intra-abdominal abscess (32,1%). Among duodenopancreactectomies 77,8% had early postoperative complications.ConclusionIts necessary to encourage early detection of tumors of the pancreas to raise the number operations with curative intent. Refinements in surgical techniques and surgical teams can diminish postoperative complications and, so, operative morbimortality can also decrease over time.

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“…The technical steps of the two main types of operation carried out are described in a previous publication 4 . While in the first half of the series to a termino-terminal invaginating pancreato-jejunal anastomosis had been preferred, from the 25th case on we chose the termino-lateral invaginating pancreatojejunal anastomosis in a single plan with separate stitches (5.0 prolene), for cases of pancreas with softened texture and/or main pancreatic duct with normal or decreased caliber.…”

Section: Methods Methods Methods Methodsmentioning

confidence: 99%

Fifty consecutive pancreatectomies without mortality

Amico

Barreto

Alves

et al. 2016

Rev. Col. Bras. Cir.

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ABSTRACT ABSTRACT ABSTRACTObjective: Objective: Objective: Objective: Objective: to report the group's experience with a series of patients undergoing pancreatic resection presenting null mortality rates. Methods:Methods: Methods: Methods: Methods: we prospectively studied 50 consecutive patients undergoing pancreatic resections for periampullary or pancreatic diseases. Main local complications were defined according to international criteria. In-hospital mortality was defined as death occurring in the first 90 postoperative days. Results:Results: Results: Results: Results: patients' age ranged between 16 and 90 years (average: 53.3). We found anemia (Hb < 12g/dl) and preoperative jaundice in 38% and 40% of cases, respectively. Most patients presented with peri-ampullary tumors (66%). The most common surgical procedure was the Kausch-----Whipple operation (70%). Six patients (12%) needed to undergo resection of a segment of the mesenteric-portal axis. The mean operative time was 445.1 minutes. Twenty two patients (44%) showed no clinical complications and presented mean hospital stay of 10.3 days. The most frequent complications were pancreatic fistula (56%), delayed gastric emptying (17.1%) and bleeding (16%). Conclusion Conclusion Conclusion Conclusion Conclusion: within the last three decades, pancreatic resection is still considered a challenge, especially outside large specialized centers. Nevertheless, even in our country (Brazil), teams seasoned in such procedure can reach low mortality rates.

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Complicações após pancreatectomias: estudo prospectivo após as novas classificações GIEDFP e GIECP

Cited by 15 publications

References 29 publications

Outcomes from mesenteric-portal axis resection during pancreatectomy

Outcomes from mesenteric-portal axis resection during pancreatectomy

Morbidity and mortality of pancreatic tumors undergoing surgical treatment

Fifty consecutive pancreatectomies without mortality

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